Clinical Laboratory Services Procedure Code 81007

TMHP has identified an issue that impacts claims that were submitted by hospitals for outpatient clients for clinical laboratory services procedure code 81007. Affected claims that were processed from April 1, 2010, through December 13, 2011, were reimbursed using an incorrect methodology. These claims were reimbursed at a percentage of the billed amount, but for outpatient claims, procedure code 81007 should be reimbursed at a fixed rate equivalent to the maximum fee for physician providers.