Clinical Laboratory Services

(A) The MassHealth agency pays the podiatrist only for laboratory tests listed in the Podiatrist Manual and only when the tests are administered and analyzed in the podiatrist's office. The MassHealth agency pays a certified independent clinical laboratory or hospital-licensed clinical laboratory if the laboratory tests are performed at the clinical laboratory. (B) The MassHealth agency pays for clinical laboratory tests that are necessary for the diagnosis or treatment of conditions of the foot only. (C) Only the following laboratory tests may be administered without prior authorization: (1) complete blood count or any of the separate components of such an analysis, including red cell count, white cell count, or hemoglobin; (2) hematocrit; (3) fungus culture; (4) sensitivity, culture, and colony count; (5) fasting blood sugar; (6) platelet count; (7) uric acid; (8) complete urinalysis; and (9) combination urinary dip stick (pH, blood, ketones, glucose, nitrites). (D) The podiatrist must include the following information with any specimen submitted to a certified independent clinical laboratory or hospital-licensed clinical laboratory: (1) a signed request for the laboratory services to be performed; (2) the member's identification number, which appears on the member's MassHealth card; and (3) the podiatrist's name, address, and provider number.