The CPT codes are consistent with the American Medical Association Current Procedural Terminology Professional Edition. The CPT code(s) published in this Directory of Services are provided for informational purposes only. The codes reflect our interpretation of CPT coding requirements, based upon AMA guidelines published annually. CPT codes are provided only as guidance to assist you in billing. MHDL strongly recommends that clients confirm CPT codes with their local intermediary or carrier, as requirements may differ from one carrier to another. CPT coding is the sole responsibility of the billing party. MHDL assumes no responsibility for billing errors due to reliance on the CPT codes listed in this Directory of Service.
Memorial Hermann Diagnostic Laboratories offers a variety of billing options. Our client services billing personnel are committed to answering all types of billing inquiries. Questions regarding bills, claims, or invoices should be directed to Memorial Hermann Patient Billing Services.
Clients and institutional accounts will be billed monthly by an itemized invoice that includes the date, patient’s name, and billable procedures by AMA CPT code, and the fee for each. Invoices are payable upon receipt. Any adjustments will appear on the following month’s statement.
Patients may be billed directly. Payments, in the form of major credit cards and bankcards.
Memorial Hermann Diagnostic Laboratories will bill your patient’s primary insurance or managed care organization directly for contract plans when provided with complete and accurate billing information. Exceptions may include insurance companies that have exclusive agreements for laboratory services.
Memorial Hermann Diagnostic Laboratories is a provider for the Medicare program and accepts assignment on all claims for covered services submitted to Medicare. Assignment does not preclude billing the patient for services denied by Medicare.
When ordering laboratory tests that are billed to Medicare/Medicaid or other federally funded programs, all regulatory requirements must be followed. Only tests that are medically necessary for the diagnosis or treatment of the patient should be ordered. Medicare does not pay for screening tests, except for certain specifically approved procedures, and may not pay for non-FDA-approved tests or those tests considered experimental.
If there is reason to believe that Medicare will not pay for a test, the patient should be informed. The patient should sign an Advance Beneficiary Notice (ABN) to indicate that he or she is responsible for the cost of the test if Medicare denies payment.
The ordering physician must provide an ICD-9 diagnosis code, not a narrative description.
AMA organ or disease oriented panels and MHDL custom panels should be billed only when all components of the panel are medically necessary. AMA panels are ordered and billed singly; MHDL custom panels are a single order, but are billed at the component level.
Medicare National Limitation Amounts for CPT codes are available through CMS or its intermediaries. Medicaid reimbursement will be equal to or less than the amount of Medicare reimbursement.
The Office of the Inspector General (OIG) takes the position that a physician who orders and the Laboratory that performs medically unnecessary tests that are submitted as a claim to the Medicare program may be subject to civil penalties.
The Deficit Reduction Act of 1984 mandates that either the performing laboratory or the referring laboratory bill Medicare directly for clinical laboratory services. Clinical diagnostic laboratory tests are reimbursed on the basis of a fee schedule.
Medicaid is a federally funded medical assistance program for those individuals who cannot afford their own health care. Medicaid claims can only be filed after all third-party resources have been used. It should be determined at the time of service if the patient has other coverage such as Medicare or other insurance. When applicable, any Medicare or other insurance information should be provided.
Billing information should be provided using the Memorial Hermann Diagnostic Laboratories requisition or during the patient registration process using the Memorial Hermann Diagnostic Laboratories web-based computer application.
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