Oklahoma Health Care Authority: Laboratory and Diagnostic Testing 2019-1

All providers should review their internal processes and procedures and ensure they are ordering and/or performing laboratory and other diagnostic tests that are medically indicated and appropriate pursuant to Oklahoma Administrative Code (OAC) 317:30-3-1(d).  This policy states, “Payment to practitioners on behalf of Medicaid eligible individuals is made only for services that are medically necessary and essential to the diagnosis and treatment of the patient’s presenting problem.  Well-patient examinations and diagnostic testing are not covered for adults unless specifically set out in coverage guidelines.”

Furthermore, OAC 317:30-5-20 states, “Only medically necessary laboratory services are compensable. Testing must be medically indicated as evidenced by patient-specific indications in the medical record” and “Laboratory testing for routine diagnostic or screening tests performed without apparent relationship to treatment or diagnosis of a specific illness, symptom, complaint or injury is not covered.  Non-specific, blanket panel or standing orders for laboratory testing, custom panels particular to the ordering provider, or lab panels which have no impact on the patient’s plan of care are not covered.”

Source: https://www.okhca.org/xProviderletters.aspx?id=736&menu=70