Sec. 10.09.09.04. Covered Services

The Program covers the following services:

A. Medically necessary laboratory services, when the services are:

(1) Rendered to recipients in a physician's office, hospital, freestanding clinic, or medical laboratory;

(2) Provided according to the laws and regulations of the state and locality in which they are rendered;

(3) Rendered pursuant to a properly completed order or standing order;

(4) Adequately documented in the provider’s files;

(5) Clinical and diagnostic services for which certification by the Centers for Medicare and Medicaid Services (CMS) under CLIA exists, if required; and

(6) Ordered by an individual who is enrolled as a provider in the Program with an active status on the date of service;

B. Transportation of specimens by medical laboratories when special handling is required by medical necessity when documentation is supplied to the provider by the authorized ordering practitioner; and

C. Collection of specimens by venipuncture, capillary puncture, or arterial puncture.