In-Office Laboratory Services

Coverage for laboratory and radiology services for Health Net's Medi-Cal plan mirrors that of the Department of Health Care Services (DHCS) fee-for-service (FFS) Medi-Cal program. Additionally, in accordance with the correct coding initiative and the Centers for Medicare and Medicaid Services (CMS), there are certain restrictions in place to ensure professional interpretation and billing are performed by specialists trained in the interpretation of radiology tests.

In-office laboratory services are only covered for certain STAT and sensitive services, when medically necessary and ordered by a Health Net provider. Supplies needed to stock the laboratory or perform the test, such as needles, syringes, slides, reagents, bandages, and labels, are included in the reimbursement for the laboratory test. Collection of venous blood by venipuncture and handling or conveyance of specimen for transfer to a laboratory are not benefits of the Medi-Cal program.

Surgical pathology is not within the scope of this policy. Laboratory tests for the evaluation and treatment of infertility are not covered under the Medi-Cal program. Tests required for the performance of family planning services or abortion are not subject to prior authorization requirements and can be provided at any facility, by any willing provider, whether in- or out-of-network.