Lab Service Frequency Limits

Retroactive to dates of service on or after January 05, 2004, laboratory services are subject to frequency limits. These limits are set per recipient, per service, per month via the Laboratory Services Reservation System (LSRS). The claim must be billed with the provider number used to make the reservation.

Frequency limits may be overridden when the provider submits medical justification to support the frequency of the laboratory service for a recipient. Laboratory claims denied due to frequency limitations may be appealed with submission of medical justification. Failure to make a laboratory service reservation prior to performing the laboratory service may result in denial of the claim.

The following entities are excluded from frequency limitations when the full laboratory service is rendered onsite: End Stage Renal Disease (dialysis) clinics, county public health clinics, Skilled Nursing Facilities (SNFs), inpatient hospitals and emergency rooms. The following programs are excluded from frequency limitations: California Children’s Services, Genetically Handicapped Persons Program and Child Health and Disability Prevention program.