MedicaidBilling CodesHigh impact
Hospital Fee-for-Service Billing of Laboratory Services
Illinois Medicaid - HFS·IL · Pathology·Provider Notice
Effective date
Dec 29, 2006
We identified it
Jun 21, 2026
Summary
Hospitals are prohibited from billing for laboratory services when specimens are sent to independent laboratories for analysis. Only the independent laboratory that performs the testing can submit claims for payment.
Action Required
Immediately: Hospital billing teams must stop submitting claims for any laboratory tests where specimens are sent to independent labs for processing. Review current billing practices to identify any instances of dual billing. Update billing workflows to ensure only tests performed on-site with hospital staff, equipment, and supplies are billed. Non-compliance will result in referral to the Office of Inspector General.