Page 99 - Medicare Benefit Policy Manual

of contact indicating dates, persons present, and issues discussed. Finally, A/B MACs
(B) should inform independent laboratories that the Medicare National Coverage
Determinations Manual as well as other guidelines contained in the manual for
determining medical necessity are on the Web site. A/B MACs (B) should also publish
local guidelines on its Web site; the A/B MAC (B) should not duplicate national
instructions here. Timely paper or electronic communications concerning the Internet
publications to independent laboratories new to the A/B MAC (B)’s service area are
essential.

80.1.3 - Independent Laboratory Service to a Patient in the Patient’s
Home or an Institution
(Rev. 1, 10-01-03)
B3-2070.1.G

Where it is medically necessary for an independent laboratory to visit a patient to obtain a
specimen, the service would be covered in the following circumstances:

1. Patient Confined to Home

If a patient is confined to the home or other place of residence used as his or her home
(see §60.4.1 for the definition of a “homebound patient”), medical necessity would exist
(e.g., where a laboratory technician draws a blood specimen). However, where the
specimen is a type which would require only the services of a messenger and would not
require the skills of a laboratory technician, e.g., urine or sputum, a specimen pickup
service would not be considered medically necessary.

2. Place of Residence is an Institution

Medical necessity could also exist where the patient’s place of residence is an institution,
including a skilled nursing facility that does not perform venipunctures. This would
apply even though the institution meets the basic definition of a skilled nursing facility
and would not ordinarily be considered a beneficiary’s home. (This policy is intended for
independent laboratories only and does not expand the range of coverage of services to
homebound patients under the incident to provision.) A trip by an independent laboratory
technician to a facility (other than a hospital) for the purpose of performing a
venipuncture is considered medically necessary only if:

a. The patient was confined to the facility; and

b. The facility did not have on duty personnel qualified to perform this service.

When facility personnel actually obtained and prepared the specimens for the
independent laboratory to pick them up, the laboratory provides this pickup service as a
service to the facility in the same manner as it does for physicians.

80.2 - Psychological Tests and Neuropsychological Tests