Approved in-office lab list

Date: July 20, 2022 

Attention: All ProvidersEffective date for procedure code 83655, lead screening: June 22, 2021Call to action: 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 point of care lab tests in their office and receive reimbursement from TCHP. All other lab tests should be referred to TCHP in network labs 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 an in network lab. The prior authorization form is available here. 

Lead  Screening

 Initial blood lead testing using point-of-care testing, procedure code 83655. This code can only be billed by a physician in an office setting (POS 11) when it is billed with modifier QW 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.