Outpatient Diagnostic Services Under Arrangements

20.4.5 - Outpatient Diagnostic Services Under Arrangements (Rev. 143, Issued: 04-29-11, Effective: 05-31-11, Implementation: 05-31-11) When the hospital makes arrangements with others for diagnostic services, such services are covered under Part B as diagnostic tests whether furnished in the hospital or in other facilities. Diagnostic services furnished under arrangement in on-campus hospital locations, off-campus hospital locations, and in nonhospital locations must be furnished under the appropriate level of physician supervision according to the requirements of 42 CFR 410.28(e) and 410.32(b)(3), as discussed in the applicable sections above. Independent laboratory services furnished to an outpatient under arrangements with the hospital are covered only under the "diagnostic laboratory tests" provisions of Part B (see Section 10, above), but are to be billed along with other services to outpatients. See Pub. 100-02, Medicare Benefit Policy Manual, Chapter 1, “Inpatient Hospital Services,” Section 50.3, for: (1) the definition of an independent clinical laboratory; (2) the requirements which such a laboratory must meet; and (3) instructions to the A/B MAC (A) when it is not approved. The “cost” to the hospital for diagnostic laboratory services for outpatients obtained under arrangements is the reasonable charge by the laboratory. Laboratory services may also be furnished to a hospital outpatient under arrangements by: 1. The laboratory of another participating hospital; or 2. The laboratory of an emergency hospital or participating skilled nursing facility that meets the hospital conditions of participation relating to laboratory services.