405 IAC 5-18-4 Nonanatomical laboratory procedures

Sec. 4. (a) The interpretation of laboratory procedures that do not require the services of a physician are not reimbursable. Medicaid reimbursement is available for the interpretation of laboratory results that require the expertise of a physician as indicated by current medical practice standards and in accordance with appropriate CPT codes. (b) Consultative pathology services are reimbursable if they: (1) are requested by the member's attending physician in writing; (2) relate to a test result that lies outside the clinically significant normal or expected range in view of the condition of the member; (3) result in a written narrative report included in the member's medical record; and (4) require the exercise of medical judgment by the consultant physician.