Temporary Change in Carrier Jurisdictional Pricing Rules for Purchased Diagnostic Services

This temporary change requires placing the referring labs’ address in field 32 on the HCFA and in loop 2010AA on the electronic format.

Until further notice, physicians/suppliers must bill their local carrier for all purchased diagnostic tests/interpretations, regardless of the location where the service was furnished. The billing physician/ supplier is responsible for ensuring that the physician/ supplier that furnished the purchased test/interpretation is enrolled with Medicare, and is in good standing (i.e., the physician/supplier is not sanctioned, barred, or otherwise excluded from participating in the Medicare program). The billing physician/supplier is also responsible for any existing billing arrangements between the purchasing entity and the entity providing the service.

When billing for an out-of-jurisdiction purchased diagnostic service, the physician/supplier must report the address of its own facility in the service facility location area of the claim. (For these services only, the place of service is deemed to be the billing physician/ supplier’s location, rather than the location where the service was actually performed. The billing physician/supplier should use the same address reported for the portion of the service that the physician/supplier performed when reporting the address for the purchased portion of the test.) Physicians/suppliers billing for the purchased test/interpretation must enter the address of their facility in block 32 of the Form CMS-1500 claim form. For electronic claims submissions, physicians/suppliers billing for the purchased test/ interpretation must enter the address of their facility in the Billing Provider loop 2010AA of the ANSI X12 837 electronic claim format, version 4010/4010A. See IOM Publication 100-04, Medicare Claims Processing Manual, chapter 1, §10.1.1.1 for further guidance concerning the submission of electronic claims.