Provider Alert! Reminder – Updated- Approved in-office lab list

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 5.3.11.6.6. 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:

COVID-19 Testing:

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:
http://www.thecheckup.org/2021/01/08/provider-alert-covid-19-disaster-declaration-covid-19-testing-expanded-to-include-out-of-network-oon-laboratories-2/

If you have any questions, please email Provider Network Management at: providerrelations@texaschildrens.org.
For access to all provider alerts, log into:
www.thecheckup.org or www.texaschildrenshealthplan.org/for-providers.