147.106 - ANATOMIC PATHOLOGY SERVICES -- BILLING.
147.106 ANATOMIC PATHOLOGY SERVICES -- BILLING.
1. A physician or a clinical laboratory located in this state or
in another state that provides anatomic pathology services to a
patient in this state shall present or cause to be presented a claim,
bill, or demand for payment for such services only to the following
persons:
a. The patient who is the recipient of the services.
b. The insurer or other third-party payor responsible for
payment of the services.
c. The hospital that ordered the services.
d. The public health clinic or nonprofit clinic that ordered
the services.
e. The referring clinical laboratory, other than the
laboratory of a physician's office or group practice, that ordered
the services. A laboratory of a physician's office or group practice
that ordered the services may be presented a claim, bill, or demand
for payment if a physician in the physician's office or group
practice is performing the professional component of the anatomic
pathology services.
f. A governmental agency or a specified public or private
agent, agency, or organization that is responsible for payment of the
services on behalf of the recipient of the services.
2. Except as provided under subsections 5 and 6, a clinical
laboratory or a physician providing anatomic pathology services to
patients in this state shall not, directly or indirectly, charge,
bill, or otherwise solicit payment for such services unless the
services were personally rendered by the clinical laboratory or the
physician or under the direct supervision of the clinical laboratory
or the physician in accordance with section 353 of the federal Public
Health Service Act, 42 U.S.C. § 263a.
3. A person to whom a claim, bill, or demand for payment for
anatomic pathology services is submitted is not required to pay the
claim, bill, or demand for payment if the claim, bill, or demand for
payment is submitted in violation of this section.
4. This section shall not be construed to mandate the assignment
of benefits for anatomic pathology services as defined in this
section.
5. This section does not prohibit claims or charges presented to
a referring clinical laboratory, other than a laboratory of a
physician's office or group practice unless in accordance with
subsection 1, paragraph "e", by another clinical laboratory when
samples are transferred between laboratories for the provision of
anatomic pathology services.
6. This section does not prohibit claims or charges for anatomic
pathology services presented on behalf of a public health clinic or
nonprofit clinic that ordered the services provided that the clinic
is identified on the claim or charge presented.
7. A violation of this section by a physician shall subject the
physician to the disciplinary provisions of section 272C.3,
subsection 2.
8. As used in this section:
a. "Anatomic pathology services" includes all of the
following:
(1) Histopathology or surgical pathology, meaning the gross and
microscopic examination and histologic processing of organ tissue
performed by a physician or under the supervision of a physician.
(2) Cytopathology, meaning the examination of cells from fluids,
aspirates, washings, brushings, or smears, including the Pap test
examination, performed by a physician or under the supervision of a
physician.
(3) Hematology, meaning the microscopic evaluation of bone marrow
aspirates and biopsies performed by a physician or under the
supervision of a physician, and the examination of peripheral blood
smears performed by a physician or under the supervision of a
physician upon the request of an attending or treating physician or
technologist that a blood smear be reviewed by a physician.
(4) Subcellular pathology and molecular pathology services
performed by a physician or under the supervision of a physician.
(5) Bloodbanking services performed by a physician or under the
supervision of a physician.
b. "Physician" means any person licensed to practice medicine
and surgery or osteopathic medicine and surgery in this state or in
another state. Section History: Recent Form
2005 Acts, ch 10, §1; 2005 Acts, ch 179, §120; 2006 Acts, ch 1185,
§73, 74; 2008 Acts, ch 1088, §95