Independent Laboratory Services

Independent Laboratory providers refer to providers with an eight digit provider number beginning with a prefix of (37).  Information regarding laboratory services for all other providers must be obtained by calling the Medicaid representative for their program such as hospital, ambulatory surgical clinics, renal dialysis, etc. 

Criteria to participate as a Kentucky Medicaid laboratory provider must include the following:

• CLIA certified to perform laboratory services and
• Have a board certified pathologist as a laboratory physician director.

A laboratory provider may perform Medicaid laboratory services for Medicaid recipients only to the extent authorized by the provider's CLIA certificate.  Laboratory services do not require prior authorization but must be medically necessary.  Reimbursement for Independent Lab is based on the Medicare fee schedule. 

Regulations, manual and site links pertaining to the laboratory program are as follows:

• Other Lab and x-ray Services - 907 KAR 1:028
• Payments for Other Lab and x-rays - 907 KAR 1:029
• Compliance with Laboratory and x-ray Services - 907 KAR 1:575
• The Independent Laboratory and Other Laboratory and x-ray Services Manual provides additional clarification regarding program policies.

Clinical Laboratory Fee Schedule as of March 2007: PDF