Laboratory Services

• Primary Care and OB/GYN Practitioner
• Specialty Care Practitioner
• Preadmission Laboratory Testing
• STAT Laboratory
• Blood Lead Screening
• Unusual Circumstances

In an effort to ensure a consistent level of quality, Gateway has contracted with many participating hospitals and laboratory facilities for outpatient laboratory services.  Gateway members are required to have all of their outpatient laboratory work completed through the appropriate contracted lab.  Failure to do so could result in non-payment of services.  At the time of the initial orientation, the primary care practitioner is required to select a designated laboratory based in the office's location and the lab used most frequently.

Gateway requires participating practitioners to utilize the member's specific designated laboratory, based on their primary care practitioner's selection, for any and all studies required for Gateway members.  The designated laboratory is listed on the member's Gateway ID Card.

All outpatient laboratory testing should be ordered with a prescription according to the primary care practitioner's designated laboratory.  If a primary care practitioner has not chosen a designated laboratory, then a referral is required with a prescription.  Specialists and OB/GYN practitioners can order laboratory testing directly, but must send the member to the member's primary care practitioner's designated laboratory listed on the member's Gateway ID Card with an order for the lab procedure to be performed.  Practitioners are encouraged to perform venipuncture in their office and arrange for the specimens to be picked up by the laboratory provider.  The name of the designated laboratory is printed on the member's Gateway Identification Card.

Participating primary care practitioners and OB/GYN practitioners who do not perform venipuncture in their office should send members to the appropriate designated laboratory. 

Certain tests can be performed in the primary care practitioner's office and are considered part of the capitation payment rendered by Gateway.  The following are routine lab services performed as capitated services:

• 81000-Routine Dip Stick
• 82270-Stool Occult Blood
• 86580-Tuberculosis, Interdermal
• 81000-Routine UA
• 85014-Hematocrit
• 86585-Tuberculosis, Tine Test

Certain Specialists are permitted to perform the following lab work in their offices as part of the authorized office visit:

ENT/Allergy:

• 86003-Allergen specific lge
• 95004-Percutaneous test (scratch, puncture, prick) with allergenic extract, immediate type reaction
• 95010-Percutaneous test (scratch, puncture, prick) sequential and incremental, with drugs, biological or venoms, immediate type reaction

Dermatology:

• 87101-Culture, fungi, isolation; skin
• 87211-Smear, wet and dry mount, for ova or parasites
• 87220-Tissue exams for fungi
• 87210-Wet mount with simple stains

Hematology/Oncology:

• 85025-H&H, WBC, Platelet count
• 85095-Bone Marrow; aspiration only
• 85102-Bone Marrow aspiration/interpretation
• 85060-Blood Smear, peripheral, interpretation by practitioner with written report
• 85097-Blood Smear interpretation only, with or without differential cell count
• 85024-Hemogram and platelet county, automated, and automated partial differential WBC count (CBC)

OB/GYN:

• 84702-Gonadotropin, chorionic (HCG); quantitative
• 84703-Gonadotropin, chorionic (HCG); qualitative

Urology:

• 81000-Urinalysis
• 89310-Motility and Mount

Gateway strongly recommends that preadmission laboratory testing be completed by the practitioner through the designated laboratory.  However, if it is not possible to utilize the designated laboratory, testing can be completed at the hospital where the procedure or admission will occur.  The primary care practitioner must issue a Gateway referral to the specific Gateway participating hospital's outpatient laboratory.

STAT laboratory services must only be utilized in urgent cases.  If a lab other than the member's designated lab is to be used, a referral form is required.  Every effort should be made to direct the member to his/her designated lab.

As part of the Growing Up with Gateway Program, primary care practitioners are required to collect and process blood lead samples for members under the age of 21.  In addition to Gateway's contracted designated laboratories, Gateway has also contracted with Kirby Health Center to process blood lead samples for Gateway members.  Kirby Health Center will process blood lead samples ONLY, and all other laboratory work must be sent to the practitioner's designated hospital or commercial laboratory.

The primary care practitioner can use either their designated laboratory or Kirby Health Center to process blood lead samples.  If you choose to send blood lead samples to Kirby Health Center, you must use the sample Lead Analysis ID Form found in the Forms and Reference Materials Section of this Manual.  The Form is only for Gateway members, and when completing the form please verify the member's eligibility. All demographic information, including the practitioner name, member name, Gateway Member Identification Number, and the date of service must be completed for the sample to be processed.

A supply kit of 20 forms, 15 postage-paid mailing envelopes, 50 capillectors for sample collection, instructions for specimen collections, and a supply reorder form may be requested through Kirby Health Center by calling 1-888-841-6699. When ordering a supply kit, please identify yourself as a participating Gateway practitioner.

Unusual Circumstances

Should circumstances arise where it is impossible to follow the laboratory procedures outlines above, please contact Gateway's Utilization Management Department at 1-800-392-1146 for assistance.