Regulation .05 Limitations.
Regulation .05 Limitations.LinkCopy Citation
The following are not covered:
A.
Services for which the medical laboratory provider cannot supply a properly completed order or standing order identifying the individual practitioner who ordered the laboratory services;
B.
Services not adequately documented in the participant’s medical records;
C.
Services denied by Medicare as not medically necessary;
D.
Clinical laboratory services, for which certification by HCFA under CLIA is required, when these services are performed by laboratories that are not certified to perform those services;
E.
Procedures that the provider knows or should know are investigational or experimental in nature;
F.
Services included by the Program as part of the charge made by an inpatient facility, hospital outpatient department, freestanding clinic, or other Program-recognized entity;
G.
Medical laboratory services related to autopsies;
H.
Medical laboratory services for which there was insufficient quantity of specimen, improper specimen handling, or other circumstances that would render the results unreliable; and
I.
Laboratory services ordered by an:
(1)
Individual who is not enrolled as a provider in the Program with an active status on the date of service; and
(2)
Entity, facility, or another provider that is not an individual.