Program Details
Beginning January 1, 2025, the Routine Lab Testing program introduces new claim edits and claim submission requirements for routine laboratory services in an outpatient setting. Laboratories performing routine laboratory testing will be required to:
- Register for the program by providing Tax ID, Group NPI, all locations billing with separate NPI’s, and contact information
- Submit a full test compendium
- If performing pathology, cytology, toxicology, and certain complex tests, answer questions on their quality credentials
- Include any proprietary test identifier that represents a test/panel on claims
- Be familiar with the new clinical guidelines
A template is available for labs to submit their test compendium and quality metrics. Failure to submit the required information by January 1, 2025, could impact reimbursement. See link below to download the template.
Note: Prior authorization for genetic tests will continue as it does today. Laboratories billing for genetic testing are encouraged to submit their genetic test compendiums if not done already. For more information on the Genetic Testing program, click here.
Note: Laboratories billing for both Genetics and Routine labs will need to submit two templates: one with their Genetics tests and a second with all tests performed.