Iowa Code 147.106 – Anatomic pathology services — billing
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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.
Terms Used In Iowa Code 147.106
- following: when used by way of reference to a chapter or other part of a statute mean the next preceding or next following chapter or other part. See Iowa Code 4.1
- Person: means a natural person. See Iowa Code 154A.1
- State: means a state, territory, or possession of the United States, the District of Columbia, or the Commonwealth of Puerto Rico. See Iowa Code 152E.3
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.