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<section article="gho" article_name="Health Occupations" number="1-306" title_number="1" title_name="Definitions; General Provisions" subtitle_number="3" subtitle_name="Patient Referrals">
  <level label="a">
    <level label="1">
      <text>In this section the following words have the meanings indicated.</text>
    </level>
    <level label="2">
      <text>“Anatomic pathology services” means:</text>
      <level label="i">
        <text>Histopathology or surgical pathology;</text>
      </level>
      <level label="ii">
        <text>Cytopathology;</text>
      </level>
      <level label="iii">
        <text>Hematology;</text>
      </level>
      <level label="iv">
        <text>Subcellular pathology and molecular pathology; or</text>
      </level>
      <level label="v">
        <text>Blood–banking services performed by pathologists.</text>
      </level>
    </level>
    <level label="3">
      <text>“Clinical laboratory” means a facility that provides anatomic pathology services.</text>
    </level>
    <level label="4">
      <level label="i">
        <text>“Cytopathology” means the microscopic examination of cells from fluids, aspirates, washings, brushings, or smears.</text>
      </level>
      <level label="ii">
        <text>“Cytopathology” includes the microscopic examination of cells in a Pap test examination performed by a physician or under the direct supervision of a physician.</text>
      </level>
    </level>
    <level label="5">
      <text>“Hematology” means:</text>
      <level label="i">
        <text>The microscopic evaluation of bone marrow aspirates and biopsies performed by a physician or under the direct supervision of a physician; or</text>
      </level>
      <level label="ii">
        <text>Review of a peripheral blood smear if a physician or technologist requests that a pathologist review a blood smear.</text>
      </level>
    </level>
    <level label="6">
      <text>“Histopathology or surgical pathology” means gross and microscopic examination of organ tissue performed by a physician or under the direct supervision of a physician.</text>
    </level>
    <level label="7">
      <level label="i">
        <text>“Referring laboratory” means a clinical laboratory that sends a specimen to another clinical laboratory for histologic processing or anatomic pathology consultation.</text>
      </level>
      <level label="ii">
        <text>“Referring laboratory” does not include a laboratory of a physician’s office or a group practice that collects a specimen and orders, but does not perform, anatomic pathology services for patients.</text>
      </level>
    </level>
  </level>
  <level label="b">
    <text>Nothing in this section may be construed to:</text>
    <level label="1">
      <text>Mandate the assignment of benefits for anatomic pathology services; or</text>
    </level>
    <level label="2">
      <text>Prohibit a health care practitioner who performs or supervises anatomic pathology services and is a member of a group practice, as defined under § 1–301 of this subtitle, from reassigning the right to bill for anatomic pathology services to the group practice if the billing complies with the requirements of subsection (c) of this section.</text>
    </level>
  </level>
  <level label="c">
    <text>A clinical laboratory, a physician, or a group practice located in this State or in another state that provides anatomic pathology services for a patient in this State shall present, or cause to be presented, a claim, bill, or demand for payment for the services to:</text>
    <level label="1">
      <text>Subject to the limitations of § 19–710(p) of the Health – General Article, the patient directly unless otherwise prohibited by law;</text>
    </level>
    <level label="2">
      <text>A responsible insurer or other third–party payor;</text>
    </level>
    <level label="3">
      <text>A hospital, public health clinic, or nonprofit health clinic ordering the services;</text>
    </level>
    <level label="4">
      <text>A referring laboratory;</text>
    </level>
    <level label="5">
      <text>On behalf of the patient, a governmental agency or its public or private agent, agency, or organization; or</text>
    </level>
    <level label="6">
      <text>A health care practitioner who orders but does not supervise or perform an anatomic pathology service on a Pap test specimen, provided the health care practitioner is in compliance with subsection (e)(2) of this section.</text>
    </level>
  </level>
  <level label="d">
    <text>Except as provided in subsection (e) of this section, a health care practitioner licensed under this article may not directly or indirectly charge, bill, or otherwise solicit payment for anatomic pathology services unless the services are performed:</text>
    <level label="1">
      <text>By the health care practitioner or under the direct supervision of the health care practitioner; and</text>
    </level>
    <level label="2">
      <text>In accordance with the provisions for the preparation of biological products by service in the federal Public Health Service Act.</text>
    </level>
  </level>
  <level label="e">
    <text>This section does not prohibit:</text>
    <level label="1">
      <text>A referring laboratory from billing for anatomic pathology services or histologic processing if the referring laboratory must send a specimen to another clinical laboratory for histologic processing or anatomic pathology consultation; and</text>
    </level>
    <level label="2">
      <text>A health care practitioner who takes a Pap test specimen from a patient and who orders but does not supervise or perform an anatomic pathology service on the specimen, from billing a patient or payor for the service, provided the health care practitioner complies with:</text>
      <level label="i">
        <text>The disclosure requirements of § 14–404(a)(16) of this article; and</text>
      </level>
      <level label="ii">
        <text>The ethics policies of the American Medical Association that relate to referring physician billing for laboratory services.</text>
      </level>
    </level>
  </level>
  <level label="f">
    <text>A patient, insurer, third–party payor, hospital, public health clinic, or nonprofit health clinic is not required to reimburse a health care practitioner who violates the provisions of this section.</text>
  </level>
</section>
