HI 00610.130 Diagnostic Laboratory Services Furnished by an Independent Laboratory
These services are covered if the laboratory is an approved independent clinical laboratory.
A. An independent laboratory
An independent laboratory is one which is independent both of the attending or consulting physician's office and of a hospital which meets at least the requirements to qualify as an emergency hospital. A laboratory which is operated by or under the supervision of a hospital which does not meet the conditions of an “emergency hospital” is considered to be an independent laboratory.
B. A clinical laboratory
A clinical laboratory is a laboratory where microbiological, serological, chemical, hematological, radiobioassay, cytological, immunohematological, or pathological examinations are performed on materials derived from the human body, to provide information for the diagnosis, prevention, or treatment of a disease or assessment of a medical condition.
C. Approved independent clinical laboratory
An approved independent clinical laboratory is one which is approved by the Secretary as meeting the specified conditions for coverage under the program.
Services rendered by an independent clinical laboratory are covered under SMI only if the laboratory has been approved under the program and only for the specialities for which it is certified. Services rendered by an approved laboratory in a specialty for which it is not certified are not covered.
Approved laboratories are listed in the Directory of Medical Facilities.