Arizona Medicaid: Help ensure covered lab services, refer patients to Labcorp

Claim rejections can cost you time and money. One way to help avoid these rejections and get paid in a timely manner is to ensure you’re referring your patients to an in-network laboratory.

For UnitedHealthcare Community Plan of Arizona members, Labcorp is the only in-network option for:

Arizona Health Care Cost Containment System (AHCCCS) Complete Care (ACC)
Developmental Disabilities (DD)
Arizona Long-Term Care Elderly Physical Disabilities (ALTCS EPD)
Medicare Dual Special Needs Plan (D-SNP) members

As it’s the only in-network lab, you must refer these patients to Labcorp for the services to be covered.

Exceptions to laboratory service requirements

Out-of-network laboratory services are covered for:

Place of service (POS) codes 19; 21; 22; 23; 24; 41/42; 51/52; 54; 55/56/57; 61/62
Emergent laboratory services coupled with a same-day procedure

Please note that Labcorp will cover laboratory:

CPT® codes 80000–89999
HCPCS codes that are covered by Medicare or AHCCCS

POS codes and names covered under exception
POS code	POS name	POS code	POS name
19	Off-campus outpatient hospital	41/42	Ambulance (any type)
21	Inpatient hospital	51/52	Inpatient psychiatric facility
22	On-campus outpatient hospital	54	Intermediate care facility
23	Hospital emergency room	55/56/57	All other psych/substance
24	Ambulatory surgery center	61/62	Comprehensive inpatient/outpatient rehab

Network providers can bill the CPT/HCPCS codes listed in the following chart for these POS locations:

POS 11 (office)
POS 49 (independent clinic)
POS 50 (Federally Qualified Health Center)
POS 53 (mental health clinic)

POS 20 (urgent care)
POS 54 (intermediate care facility)
POS 71/72 (rural health clinic)

Allowed CPT/HCPCS codes POS 11, POS 20, POS 49, POS 50, POS 53, POS 54, POS 71/72
81000	81002	81025	82270	84030	85013	85014
86490	86580	87210	87804	87880	89190	36415
36416	99000	P9612	Q0091	Q0111	Q0112	Q0113
Q0114	S3620
Effective May 1, 2022 for Medicaid (Not D-SNP)
80061	80305*	82075*	82247	83036	83655	87502

*Codes 80305 and 82075 will be billed and reimbursed when the service is considered medication-assisted treatment (MAT) related as outlined in the UnitedHealthcare Community Plan Physician Health Care Professional, Facility and Ancillary Provider Administrative Guide for Arizona state programs.

Questions?
Please call ACC/DD Provider Services at 800-445-1638 or ALTCS EPD Provider Services at 800-293-3740. To find the nearest Labcorp location, go to labcorp.com and search by address or ZIP code. Thank you.

CPT^® is a registered trademark of the American Medical Association.

PCA-1-23-03127-Clinical-NN_10062023

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