CMS Pub. 100-04, ch. 16, § 50.5.2

B3-3102

EXAMPLE 1:

Scenario 1:

An independent laboratory located in Oregon performs laboratory services for physicians

whose offices are located in several neighboring States. A physician from Nevada sends

specimens to the Oregon laboratory.

Jurisdiction: The A/B MAC (B) in Oregon has jurisdiction.

EXAMPLE 2:

Scenario 2: American Laboratories, Inc., is an independent laboratory company with

branch laboratories located in Philadelphia, PA and Wilmington, DE, as well as regional

laboratories located in Millville, NJ and Boston, MA.

The Philadelphia laboratory receives a blood sample from a patient whose physician

ordered a complete blood count, a basic metabolic panel and a B12 and folate. The

Philadelphia laboratory performs the complete blood count, but the basic metabolic panel

is performed at the Millville laboratory, while the B12 and folate is performed at the

Boston Laboratory.

Jurisdiction: The Pennsylvania A/B MAC (B) may retain jurisdiction for processing the

claim for all of the services. The A/B MAC (B) servicing Boston and/or Millville may

have jurisdiction for processing their claims if those laboratories bill for the services they

perform, but the Philadelphia laboratory is barred from billing for the services that

Boston and Millville submit for payment.

EXAMPLE 3:

Scenario 3: Same relationships as in Example 2. American Laboratories, Inc., is an

independent laboratory company with branch laboratories located in Philadelphia, PA

and Wilmington, DE, as well as regional laboratories located in Millville, NJ and Boston,

MA.

This time the Wilmington laboratory draws a blood specimen from a patient whose

physician has ordered a blood culture. The Wilmington laboratory then sends the

specimen to the Boston laboratory, which performs the required test.

Jurisdiction: The A/B MAC (B) processing claims for providers/suppliers located in

Delaware may retain jurisdiction for processing the claim. If the laboratory in Boston

chooses to bill for the service to the Massachusetts A/B MAC (B), then the Wilmington

laboratory may not bill for the service.