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KMAP BULLETIN: Laboratory Billing & Verification of CLIA Status of Performing Laboratories

Date: 03/12/21

KMAP GENERAL BULLETIN 21022 (PDF)

Effective with dates of services on and after April 1, 2021, Kansas Medical Assistance Program (KMAP)-enrolled hospitals, physicians, or independent laboratories may bill for laboratory services if the services are performed:

  • In their laboratory; OR
  • By an independent laboratory enrolled as a KMAP provider; OR
  • By an independent laboratory not enrolled as a KMAP provider, the KMAP-enrolled hospital, physician, or independent laboratory confirms the Clinical Laboratory Improvement Amendments (CLIA) status of the performing laboratory prior to billing KMAP for those services. The appropriate CLIA certification and documented process for CLIA status verification must be on file and available upon request.

Laboratory services billed by the KMAP-enrolled hospital, physician, or independent laboratory for laboratory services performed by an independent laboratory (as specified above), may be appended with modifier 90.

Note: When laboratory procedures are performed by a party other than the treating or reporting physician or other qualified health care professional, the procedure may be identified by adding modifier 90 to the usual procedure number. Note: The effective date of the policy is April 1, 2021. The implementation of State policy by the KanCare Managed Care Organizations (MCOs) may vary from the date noted in the Kansas Medical Assistance Program (KMAP) bulletins. The KanCare Open Claims Resolution Log on the KMAP Bulletins page documents the MCO system status for policy implementation and any associated reprocessing completion dates, once the policy is implemented