HI 00601.035 Other Diagnostic or Therapeutic Items or Services

Other diagnostic or therapeutic items or services ordinarily furnished inpatients by the hospital or by others under arrangements made by the hospital are covered. Such services to hospital inpatients may be covered under Part A even when furnished off the hospital premises. For example, diagnostic or therapeutic services of an audiologist off the hospital premises are covered if billed by the hospital under arrangements, if the services are furnished at a speech and hearing center, and if the audiologist meets certain qualifications. With respect to items that leave the hospital with the patient when he is discharged, such as splints or casts, the rules for determining whether the item is covered are the same as in HI 00601.030.

A. Diagnostic services of psychologists and physical therapists

When a psychologist or physical therapist is a salaried member of the staff of a hospital, his diagnostic or therapeutic services to inpatients of that hospital are covered on a reasonable cost basis in the same manner as the services of other nonphysician hospital employees. The services of a psychologist or physical therapist who is not a salaried staff member are covered if furnished by the hospital as part of the services it ordinarily furnishes under arrangements which provide for billing to be handled by the hospital.

B. Diagnostic services of independent clinical laboratories

Diagnostic services furnished to an inpatient by an independent clinical laboratory under arrangements with the hospital are reimbursable under hospital insurance.

An independent laboratory is one which is independent both of the attending or consulting physician's office and of a hospital which is participating in the program as a provider of services.

A clinical laboratory is a laboratory where micro-biological, serological, chemical, hematological, bio-physical, cytological, immunohematological or pathological examinations are performed on materials derived from the human body to provide information for diagnosis, prevention, or treatment of a disease or assessment of a medical condition.

C. Diagnostic service under arrangement

Diagnostic services furnished a hospital inpatient under arrangements with a laboratory of another participating hospital are reimbursable on a cost basis under Part A to the hospital obtaining the services.


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http://policy.ssa.gov/poms.nsf/lnx/0600601035
HI 00601.035 - Other Diagnostic or Therapeutic Items or Services - 04/03/2015
Batch run: 04/03/2015
Rev:04/03/2015