Policies & Guidelines
- Compliance
- Definitions
- Ambulatory Surgical Services
- Billing Policy
- Children's Services
- Chiropractic Services
- Clinic Services
- Dental
- HCBS Elderly Waiver
- Home Care
- Hospice
- Hospital Services
- Inpatient Hospital Notification and Authorization
- Laboratory/Pathology, Radiology and Diagnostic Services
- Long-Term Care
- Mental Health Services
- Optical Services
- Pharmacy Services
- Physician and Professional Services
- Rehabilitative Services
- Requirements for Providers
- Service Authorization
- Substance Use Disorder Services
- Transportation
- Tribal and Indian Health Services
- Legal References
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- Ambulatory Surgical Services
- Billing Policy
- CFSS
- Children's Services
- Chiropractic Services
- Clinic Services
- Dental
- Equipment and Supplies
- HCBS Elderly Waiver
- Home Care
- Hospice
- Hospital Services
- Housing Stabilization Services
- Immunizations and Vaccinations
- Inpatient Hospital Notification and Authorization
- Laboratory/Pathology, Radiology and Diagnostic Services
- Long-Term Care
- Member Eligibility
- Mental Health Services
- Optical Services
- Pharmacy Services
- Physician and Professional Services
- Recuperative Care
- Rehabilitative Services
- Requirements for Providers
- Service Authorization
- Substance Use Disorder Services
- Transportation
- Tribal and Indian Health Services
- Quality: HEDIS
- Policies & Procedures
Laboratory/Pathology, Radiology, and Diagnostic Services
Definitions
Laboratory: A facility that performs laboratory testing on specimens derived from humans for the purpose of providing information on diagnosis, prevention care, health assessment, or treatment of diseases or impairments.
Panel Codes: Groups of laboratory tests (components) that are frequently performed together. Tests included in each panel are listed by name with the Current Procedural Terminology (CPT) code identified in parentheses. In order to report a panel code, all listed tests must be performed.
Pathology: A service requiring additional medical interpretive decision, consisting of a written report performed by a pathologist, at the request of a physician.
Professional Component: A physician’s exam (when indicated), performance or supervision, interpretation, or written report of a diagnostic test.
Provider-Performed Microscopy Procedures (PPMP): Allows physician office laboratories to perform a limited number of microscopy procedures. Certified PPMP-approved procedures are subject to change at any time.
Technical Component: Includes the personnel and materials, including contrast media and drugs, film or xerography, space, equipment, or other facilities.
Waived Complexity: The Centers for Medicare & Medicaid Services (CMS) has identified a number of simple laboratory procedures that can be performed in the physician offices after obtaining a Certificate of Waiver. Waived tests are subject to change at any time, so review all Medicare mailing for changes to waived tests.
PW_03-19_137
Updated_12/11/2025
