Laboratory Services Furnished to Nonhospital Patients by

70.5 - Laboratory Services Furnished to Nonhospital Patients by Hospital Laboratory (Rev. 82; Issued: 02-08-08; Effective: 01-01-08; Implementation: 03-10-08) A nonhospital patient is an individual who is neither an inpatient nor outpatient of the hospital furnishing the service. (See the Medicare Benefit Policy Manual, Pub. 100-02, Chapter 1, “Inpatient Hospital Services,” section 10, for the definition of a hospital inpatient and section 20.1 for the definition of a hospital outpatient). Nonhospital patients primarily are individuals from whom a specimen had been taken and sent to the hospital for analysis and the patient does not receive hospital outpatient services on the same day. For all hospitals except CAHs and Maryland waiver hospitals, if a beneficiary receives hospital outpatient services on the same day as a specimen collection and laboratory test, then the patient is considered to be a registered hospital outpatient and cannot be considered to be a non-patient on that day for purposes of the specimen collection and laboratory test. However if the non-CAH or Maryland waiver hospital only collects or draws a specimen from the beneficiary and the beneficiary does not also receive hospital outpatient services on that day, the hospital may choose to register the beneficiary as an outpatient for the specimen collection or bill for these services as non- patient on the 14X bill type. For CAHs, payment for clinical diagnostic laboratory tests is made at 101 percent of reasonable cost, only if the individuals are outpatients of the CAH, as defined in 42 CFR 410.2, and are physically present in the CAH at the time the specimens are collected. Clinical diagnostic laboratory tests performed for persons who are not physically present (non-patients) at the CAH when the specimens are collected are made in accordance with the provisions of sections 1833(a)(1)(D) and 1833(a)(2)(D) of the Social Security Act. See also 42 CFR 413.70(b)(iii). Similarly, for Maryland waiver hospitals, the waiver is limited to services to inpatients and registered outpatients as defined in 42 CFR 410.2. Therefore payment for non-patients (specimen only, TOB 14X) who are not registered outpatients at the time of specimen collection will be made on the clinical diagnostic laboratory fee schedule. Such services are covered to the extent appropriate. See the Medicare Claims Processing Manual, Pub. 100-04, Chapter 16, “Laboratory Services from Independent Labs, Physicians, and Providers,” section 40.3, for billing and payment of clinical diagnostic laboratory services for patients and non-patients.