Mountain State Medical Policy Bulletin
Section: Laboratory
Number: L-2
Topic: Collection of Specimens
Effective Date: January 1, 2006
Issued Date: January 2, 2006
Date Last Reviewed: 08/2006

General Policy Guidelines

Indications and Limitations of Coverage

The collection of specimens should be recognized as an eligible procedure when reported as a separate service.

Note:  Procedure code 99000 represents the handling and/or conveyance of a specimen for transfer from the physician's office to a laboratory.  Please see Medical Policy Bulletin Z-39 (Provider Overhead Expenses) for guidelines on code 99000.
         

Procedure Codes

36415364163660099000P9612S9529

Traditional Guidelines

Refer to General Policy Guidelines

FEP Guidelines

Payment should be made for one collection per date of service to physicians only in instances where a venipuncture (36415) is performed and the blood specimen is referred to an outside laboratory.

The handling and/or conveyance of blood (99000) is an integral part of the collection service. The charge for the handling and/or conveyance of blood should be combined with the allowance for the venipuncture and benefits should be provided up to the allowable charge for the venipuncture.

Benefits are available for specimen (e.g., urine, stool) conveyance and/or handling for transfer to a laboratory (99000). However, when billed with the laboratory test, 99000 should be denied.

Collection of other specimens (e.g., urine, stool) is considered an integral part of the medical visit.

Also refer to General Policy Guidelines

PPO Guidelines

Refer to General Policy Guidelines

Managed Care POS Guidelines

Refer to General Policy Guidelines

Publications

PRN References

08/1993, Venipuncture, codes for,

References

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Glossary




This policy is designed to address medical guidelines that are appropriate for the majority of individuals with a particular disease, illness, or condition. Each person's unique clinical circumstances may warrant individual consideration, based on review of applicable medical records.

Medical policies are designed to supplement the terms of a member's contract. The member's contract defines the benefits available; therefore, medical policies should not be construed as overriding specific contract language. In the event of conflict, the contract shall govern.

Medical policies do not constitute medical advice, nor the practice of medicine. Rather, such policies are intended only to establish general guidelines for coverage and reimbursement under Mountain State Blue Cross Blue Shield plans. Application of a medical policy to determine coverage in an individual instance is not intended and shall not be construed to supercede the professional judgment of a treating provider. In all situations, the treating provider must use his/her professional judgment to provide care he/she believes to be in the best interest of the patient, and the provider and patient remain responsible for all treatment decisions.

Mountain State Blue Cross Blue Shield (MSBCBS) retains the right to review and update its medical policy guidelines at its sole discretion. These guidelines are the proprietary information of MSBCBS. Any sale, copying or dissemination of the medical policies is prohibited; however, limited copying of medical policies is permitted for individual use.