Benefit: Lab / X-ray

Definition:  A laboratory is a place where tests are done to get information about the health of a patient. An x-ray is a picture of something such as a bone, joint, muscle or organ to determine a medical condition. Laboratory and x-ray services are performed in several settings, e.g., inpatient hospital, outpatient hospital, clinic and doctor’s office.

Limits:  Laboratory -- The frequency of some tests is limited.
X-ray: -- Medicaid reimbursement for portable x-ray services is limited to one unit of service, per procedure, per recipient, per day.

Exceptions: Laboratory Exceptions:  The frequency limitations for certain procedure codes may be exceeded based on diagnosis codes.

Co-pays: Labs: There is a $1 beneficiary co-payment for independent laboratory services, per provider, per day, unless the beneficiary is exempt.

Reform items that can vary: None