CMS Pub. 100-04, ch. 19, § 100.14

• Laboratory services furnished to IHS provider inpatients are combined with other

inpatient services furnished and reported under revenue code 0100 (all-inclusive

room and board plus ancillary) on TOB 11X. Payment is made for inpatient

laboratory services under the PPS based upon DRGs.

• Inpatient hospital laboratory ancillary services are covered under Medicare Part B

when coverage is no longer provided under Medicare Part A.

The IHS providers are paid for covered inpatient hospital laboratory ancillary

services based upon an AIR. All inpatient ancillary charges are combined and

reported under revenue code 024X (all-inclusive ancillary) on TOB 12X.

• Laboratory services furnished to IHS provider inpatients under arrangements are

combined with other inpatient services furnished and reported under revenue code

0100 (all-inclusive room and board plus ancillary) on TOB 11X. Payment is made

for inpatient laboratory services under the IPPS based upon DRGs.

The term “arrangements” means arrangements that provide that Medicare

payment made to the provider that arranged for the services discharges the

liability of the beneficiary or any other person to pay for those services. Medicare

does not pay any provider or supplier other than the IHS provider for services

furnished to a beneficiary who is an inpatient.

• Charges for laboratory services furnished to outpatients of IHS providers are

combined with all other outpatient charges for the same date of service and

reported under revenue code 0510 (clinic visit) on TOB 13X (tribal hospitals and

hospital-based clinics) Payment is made on the outpatient per visit AIR (OMB

rate).

• The IHS swing-bed facilities are paid according to the SNF PPS. SNF PPS

payment includes payment for all medically necessary inpatient ancillaries,

including laboratory services. Revenue code 0022 and HIPPS codes are reported

on the bill along with the accommodation and ancillary revenue codes. All

services are itemized and billed with the appropriate revenue code that describes

the service on TOB 18X.

• Charges for covered inpatient laboratory services provided in a CAH are

combined with all other inpatient charges and reported under revenue code 0100

(all inclusive room and board plus ancillary) on TOB 11X. Payment is based on

101 percent of the all inclusive facility specific per diem rate.

• Inpatient CAH laboratory ancillary services are covered under Medicare Part B

when coverage is unavailable under Medicare Part A.

Charges for inpatient CAH laboratory services are combined with charges for

other inpatient ancillary services and reported under revenue code 024X (all-inclusive ancillary) on TOB 12X. Payment is based on 101 percent of an all-inclusive facility specific per diem rate.

• Covered CAH outpatient laboratory service charges are combined with all other

outpatient charges for the date of service and reported under revenue code 0510

(clinic visit) on TOB 85X. Payment is based on 101 percent of the facility specific

per visit rate.

• Swing-bed laboratory service charges are combined with all other swing bed

charges in IHS CAHs and are billed under revenue code 0100 (all-inclusive room

and board plus ancillary) on TOB 18X. Payment is made on a cost based per diem

amount.