MHTL 3345-10-01 (Disallowance of Separate Reimbursement for
Blood-Glucose Testing in a Long-Term Care Setting)
Medicaid Handbook Transmittal Letter (MHTL) No.
November 22, 2010
TO: Long-term care facilities
Other providers of laboratory services
Directors, County Departments of Job and Family Services
FROM: Douglas E. Lumpkin, Director
SUBJECT: Disallowance of separate reimbursement for
blood-glucose testing in a long-term care setting
Under current administrative rules governing laboratory
tests, claims that are submitted to Medicaid by a long-term
care facility (LTCF) for drawing blood specimens and for
performing routine procedures are not separately
reimbursable. Paragraph (B) of rule 5101:3-3-19 and
paragraph (B) of rule 5101:3-3-19.1 of the Ohio
Administrative Code specify that "costs incurred [by a
long-term care facility]...for drawing specimens and
forwarding specimens to a laboratory...are reimbursable
through the facility's cost report" (i.e., payment is
included in the facility's per diem amount). Paragraph
(K)(1)(b) of rule 5101:3-11-03 of the Ohio Administrative
Code states that "routine laboratory and screening
procedures" are not reimbursable at all.
It is the policy of Ohio Medicaid that blood-glucose
testing performed for a resident of a LTCF is a routine
laboratory screening procedure. Therefore, it is not
separately reimbursable to either LTCFs or independent
laboratories. (Applicable procedure codes include but are
not necessarily limited to CPT 36416 for taking a blood
sample and CPT 82948 and 82962 for performing the
Accordingly, neither LTCFs nor independent laboratories may
submit claims for blood-glucose testing performed for LTCF
residents. Even if the Medicaid claims-processing system
should accept them, such claims are disallowed by policy.
Any resulting reimbursement is subject to recovery.
Access to Rules and Related
The Ohio Department of Job and Family Services maintains an
"electronic manuals" web page of the department's rules,
manuals, letters, forms, and handbooks. The URL for this
"eManuals" page is
From the "eManuals" page, providers may view documents
online by following these steps:
(1) Select the 'Ohio Health Plans - Provider' folder.
(2) Select the appropriate subfolder (e.g.,
(3) Select the appropriate topic (e.g., 'Laboratory
Rules' or 'Medicaid Handbook Transmittal Letters') from the
(4) Select the desired item from the 'Table of
Contents' pull-down menu.
The Legal/Policy Central - Calendar web site ( http://www.odjfs.state.oh.us/lpc/calendar/ )
is a quick reference for finding documents that have
recently been published. This site includes a link to a
separate web page ( http://www.odjfs.state.oh.us/lpc/mtl/ )
that displays a list of ODJFS manual transmittal letters.
The list is categorized by subject and transmittal letter
number, and each item is linked to an easy-print version in
Portable Document Format (PDF).
Questions pertaining to this MHTL should be addressed to:
Office of Ohio Health Plans
Bureau of Provider Services
P.O. Box 1461
Columbus, OH 43216-1461