Provider Alert! Reminder – Updated- Approved in-office lab listTexas Children's Health Plan
Date: September 9, 2021
Attention: All Providers
Effective date for procedure code 83655, lead screening: June 22, 2021
Call to action: Texas Children’s Health Plan (TCHP) utilizes Quest Diagnostics as our exclusive reference lab provider. This alert is to serve as a reminder of the specific labs on our pre-approved list that may be run in a network provider’s office.
How this impacts providers: Providers may perform specific lab tests in their office and receive reimbursement from TCHP. All other lab tests must be referred to Quest Diagnostics or State of Texas Laboratories. Per state regulations, laboratory specimens that are required to be sent to state laboratories for processing will continue to follow guidelines available here: https://www.dshs.texas.gov/lab/remotedata.shtm.
As a reminder, all genetic testing requires a prior authorization, with the exception of Cystic Fibrosis and Spinal Muscular Atrophy Screening effective June 1, 2021, even when processed by Quest Diagnostics. The prior authorization form is available here.
Effective June 22, 2021, initial blood lead testing using point-of-care testing, procedure code 83655 with modifier QW, may be billed to a THSteps visit per guidance from TMPPM, Children Services Handbook, section 18.104.22.168.6. Providers must have a Clinical Laboratory Improvement Amendments (CLIA) certificate of waiver.
Blood lead testing is part of the encounter rates for FQHCs and RHCs and is not reimbursed separately.
Reporting all blood lead levels is a law in Texas. For more information, https://www.dshs.texas.gov/lead/Reporting-Laws-Administrative-Code.aspx
Next steps for providers: Providers may only perform the following pre-approved labs in their office and bill with the correct CPT code:
|81000||Urinls Dip Stick/Tablet Reagnt Non-Auto Micrscpy|
|81001||Urinalysis with Microscopy, Automated|
|81002||Urnls Dip Stick/Tablet Rgnt Non-Auto w/o Micrscp|
|81003||Urinalysis w/o Microscopy, Automated.|
|81007||Urine Screen for Bacteria|
|81025||Urine Pregnancy Test Visual Color Cmprsn Meths|
|82009||Acetone or Other Ketone Bodies|
|82044||Urine Dipstick for Micro-Albumin|
|82120||Amines Vaginal Fluid Qualitative|
|82270||Blood Occult Peroxidase Actv Qual Feces 1 Deter|
|82465||Cholesterol Serum/Whole Blood Total|
|82731||Ftl Fibronectin Cervicovag Secretions Semi-Quan|
|82947||Glucose Quantitative Blood Xcpt Reagent Strip|
|82948||Glucose, Blood Reagent Strip|
|82950||Glucose Post Glucose Dose|
|82948||Glucose Blood Test|
|84450||Transferase Aspartate Amino Ast Sgot|
|84460||Transferase Alanine Amino Alt Sgpt|
|84703||Chorionic Gonadotropin Assay|
|85007||Blood Count Smear Mcrscp w/Mnl Difrntl WBC Count|
|85014||Blood Count Hematocrit|
|85018||Blood Count Hemoglobin|
|85025||Blood Count Complete Auto & Auto Difrntl WBC Count|
|85027||Blood Count Complete Automated|
|86308||Heterophile Antibodies Screen|
|86403||Particle Agglutination (Rapid Strep)|
|86580||TB (INTRADERMAL & TINE)|
|87081||Cul Prsmptv Pthgnc Organism Scrn w/Colony Estimj|
|87210||Smr Prim Src Wet Mount Nfct Agt|
|87220||KOH—tissue exam for fungi|
|87420||Iaad Eia Respiratory Synctial Virus-Infectious agent antigen detection by immunoassay technique|
|87800||Infectious agent detection by nucleic acid -ladna Multiple Organisms Direct Probe TQ|
|For laadiado, infectious agent antigen detection by immunossay with direct optical observation for these:|
|87801||Infectious agent detection by nucleic acid (DNA or RNA), multiple organisms; amplified probe(s) technique|
|87807||Iaadiadoo Respiratory Synctial Virus- Infectious agent antigen detection by immunoassay with direct optical observation; respiratory syncytial virus|
|87880||Iaadiadoo Streptococcus Group A|
|88720||Bilirubin Total Transcutaneous|
|89060||Crystal Id Light Microscopy Alys Tiss/Any Fluid|
|80305||Drug test(s), presumptive, any number of drug classes, any number of devices or procedures|
|80306||Drug test(s), presumptive, any number of drug classes, any number of devices or procedures|
|87502||Infectious agent detection by nucleic acid (DNA or RNA); influenza virus|
|87651||Infectious agent detection by nucleic acid (DNA or RNA); Streptococcus, group A, amplified probe technique|
|83036||Hemoglobin; glycosylated (A1C)|
|83037||Hemoglobin; glycosylated (A1C) by device cleared by FDA for home use|
|87634||Infectious agent detection by nucleic acid (DNA or RNA); respiratory syncytial virus, amplified probe technique|
Special guidance is in place during the disaster declaration period regarding COVID-19 testing; please refer to the Provider Alert that posted titled COVID-19 Testing expanded to include Out-of-Network (OON) Laboratories. Here is a link to the alert:
If you have any questions, please email Provider Network Management at: email@example.com.
For access to all provider alerts, log into:
www.thecheckup.org or www.texaschildrenshealthplan.org/for-providers.
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