Specimen Validity Testing

According to 100-4, ch 16,§10, a diagnostic laboratory test must be ordered by the treating physician and the test results must be used in the management of the beneficiary’s specific medical problem. Although some laboratory requisitions allow the ordering physician to designate specimen validity testing (eg: creatinine, oxidant, pH, specific gravity) to ensure that a patient specimen has not been adulterated, the results of this testing are not used in the management of the beneficiary’s medical problem. Therefore, Palmetto GBA has determined that specimen validity testing is a statutorily excluded service.

MAC for Jurisdiction 11; comprised of North Carolina, South Carolina, Virginia and West Virginia; and MAC for Jurisdiction 1; comprised of California, Hawaii and Nevada.