For Health Maintenance Organization (HMO) and Point-of-Service (POS) products, STAT laboratory (lab) tests performed in an outpatient hospital setting are covered and eligible for reimbursement consideration by the Company when they are performed to obtain immediate results to assist in determining an individual's course of treatment. For a list of eligible STAT lab tests, refer to Attachment A.
Precertification and referrals are not required for the STAT lab tests listed in Attachment A. These tests may be performed by any participating hospital laboratory, provided that a participating provider (ie, the individual's primary care physician [PCP] or specialist) requests the STAT lab test via a written order.
Lab tests that are not included in Attachment A require precertification if they are to be performed on a STAT basis. When ordered in conjunction with STAT lab tests, routine lab tests require precertification in order to be eligible for additional reimbursement consideration.
