Laboratory Services Outpatient Payment Schedule
Purpose of the Payment Schedule
The Laboratory Services Outpatient Payment Schedule is issued by the Ministry of Health under the authority of the Laboratory Services Act (the LSA) for use by operators of approved laboratory facilities in British Columbia. The Payment Schedule is effective as of October 1, 2015.
The Payment Schedule applies to the provision of insured outpatient services in approved laboratory facilities receiving payment on a fee-for-service (FFS) basis. The Payment Schedule contains billing and payment detail for laboratory operators, a schedule of laboratory medicine fees, as well as limits and conditions on laboratory benefits approved for referring medical and health care practitioners.
The Preamble within the Payment Schedule complements the Schedule of Fees (Sections One through Seven), including Notes found within each Section by sub-discipline. The intention is that, together, the Preamble and Notes will assist operators in billing for insured outpatient laboratory services. If there is an inadvertent conflict between a fee item description in the Schedule of Fees and information in the Preamble, the interpretation of the fee item description in the Schedule of Fees shall prevail.
The Schedule of Fees and associated fee item values are approved by the Minister and are payable to operators of approved laboratory facilities on a FFS basis for insured outpatient laboratory medical services provided to beneficiaries enrolled with the Medical Services Plan (MSP).
Legislation and Policy
The Laboratory Services Act empowers the Minister of Health as being responsible for the administration and provision of laboratory services as benefits under the LSA. The LSA replaces the provisions for laboratory services as benefits administered under the Hospital Insurance Act and the Medicare Protection Act.
The LSA establishes a relationship between the minister and providers (operators) for the provision of laboratory services in British Columbia. In addition, the statute provides the minister with the authority to set outpatient laboratory fees and to determine the amount of all fees.
The payment schedule functions as the primary claim processing and payment policy document for insured FFS outpatient laboratory services in British Columbia. The payment schedule is maintained by the Laboratory, Diagnostic and Blood Services Branch of the Ministry of Health and will be reviewed and updated as required based on best evidence and consultation with stakeholders.
Components of the Payment Schedule
The Laboratory Services Payment Schedule consists of a Preamble and a separate Schedule of Fees.
The Preamble includes:
- An Introduction for operators of approved laboratory facilities;
- A facility Operations and Administration chapter with billing and payment procedures, record keeping requirements, and service provisions;
- An introduction for operators to Laboratory Services and Fees;
- Information regarding Referring Medical and Health Care Practitioners, including limits and conditions on certain laboratory tests and services;
- A Glossary of Terms; and
- The Payment Schedule Index of Amendments.
The Payment Schedule consists of the following sections by sub-discipline, and includes the respective fee item numbers (codes), test description, limits and conditions (Notes), and fee item value:
Section One: Hematology and Blood Bank Fee Items
Section Two: Microbiology Fee Items
Section Three: Chemistry Fee Items
Section Four: Cytogenetics Fee Items
Section Five: Virology Fee Items
Section Six: Anatomic Pathology Fee Items
Section Seven: Other Fee Items
Laboratory Volume Discounting (LVD)
The Province of British Columbia and the Doctors of BC have historically entered into laboratory medicine fee agreements that establish annual expenditure targets and use a discounting mechanism to manage costs for outpatient fee-for-service laboratory testing. As of October 1, 2015, such agreements are no longer in effect; instead the Minister of Health is responsible for determining the amount paid for a laboratory service. For outpatient laboratory services paid on a fee-for-service basis, the Ministry of Health will continue to apply the LVD model with 62% of 2011/12 volumes of 56 fee items paid at 100% and volumes greater than 62% discounted at 50%.