CMS Pub. 100-02, ch. 15, § 80.1.3

Institution

(Rev. 1, 10-01-03)

B3-2070.1.G

Where it is medically necessary for an independent laboratory to visit a patient to obtain a specimen, the

service would be covered in the following circumstances:

1. Patient Confined to Home

If a patient is confined to the home or other place of residence used as his or her home (see §60.4.1 for the

definition of a “homebound patient”), medical necessity would exist (e.g., where a laboratory technician

draws a blood specimen). However, where the specimen is a type which would require only the services of

a messenger and would not require the skills of a laboratory technician, e.g., urine or sputum, a specimen

pickup service would not be considered medically necessary.

2. Place of Residence is an Institution

Medical necessity could also exist where the patient’s place of residence is an institution, including a skilled

nursing facility that does not perform venipunctures. This would apply even though the institution meets the

basic definition of a skilled nursing facility and would not ordinarily be considered a beneficiary’s home.

(This policy is intended for independent laboratories only and does not expand the range of coverage of

services to homebound patients under the incident to provision.) A trip by an independent laboratory

technician to a facility (other than a hospital) for the purpose of performing a venipuncture is considered

medically necessary only if:

a. The patient was confined to the facility; and

b. The facility did not have on duty personnel qualified to perform this service.

When facility personnel actually obtained and prepared the specimens for the independent laboratory to pick

them up, the laboratory provides this pickup service as a service to the facility in the same manner as it does

for physicians.