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Claims & Payment Policy: Physician Office Lab Testing (Effective 02102021)

January 7, 2021

Dear Provider,

WellCare is implementing the following policy for Physician’s Office Laboratory Testing (POLT) with an effective date as of February 10, 2021.

Summary of Policy: The purpose of this policy is to define payment criteria for in-office laboratory procedures to be used in making payment decisions and administering benefits. Furthermore, the intent of this policy is to encourage the specialization of independent labs to ensure higher quality laboratory tests are performed in the appropriate setting.

What does this mean for providers?

To ensure higher quality laboratory tests are performed in the correct setting, the health plan will limit the performance of in-office laboratory testing to the CPT® and HCPCS codes listed in the Short Turnaround Time (STAT) laboratory (lab) code list included in this policy.

The following is policy criteria for Physician’s Office Lab Testing:

If 80000-89999 (Laboratory service), 0014M, G2023, G2024, U0001, U0002, U0003 or U0004 are billed in place of service 11 (Office) and are not listed in the Short Turnaround Time (STAT) laboratory or CLIA code list, then the laboratory service will be denied with the reason ‘Place Of Service Inappropriate For Procedure’.

The provider will have the option to dispute/appeal the denial.

WellCare is committed to assisting the provider during this time of adjustment. Additional information regarding the policy will be made available during the implementation process. Providers can review the complete policy at www.wellcare.com/providers, select your state, select Claims, then Payment Policy.

We are here to help. Please contact your Network Representative for general inquiries regarding this program.<

Sincerely,

     WellCare Health Plans 

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Last Updated On: 1/7/2021