Clinical Laboratory Services: Introduction

Clinical laboratory services necessary for the diagnosis, treatment, and prevention of disease and for the maintenance of the health of a member are payable under MassHealth. (A) Provider Eligibility. The MassHealth agency pays for laboratory tests only when they are performed on a member by a physician, certified nurse practitioner, certified nurse midwife, certified registered nurse anesthetist, psychiatric clinical nurse specialist, clinical nurse specialist, or physician assistant, or by an independent clinical laboratory certified by Medicare. (B) Payment. The MassHealth agency pays a physician, certified nurse practitioner, certified nurse midwife, certified registered nurse anesthetist, psychiatric clinical nurse specialist, clinical nurse specialist, or group practice employer of such practitioners or of a physician assistant only for laboratory tests performed in the practitioner’s office. If an independent clinical laboratory performs laboratory tests for a member, the MassHealth agency pays only the laboratory for those services. (C) Information with Specimen. A physician who sends a specimen to an independent clinical laboratory participating in MassHealth must also send the following: (1) a signed request for the laboratory services to be performed; (2) the member's MassHealth identification number; and (3) the physician's name, address, and provider number.