The Laboratory Services Act (LSA) replaces provisions for laboratory services 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 the fees.
Under the authority of the LSA, the Minister of Health is responsible for the administration and provision of laboratory services as benefits. The Ministry of Health issues the Outpatient Payment Schedule to operators of approved BC laboratory facilities. This schedule applies to outpatient laboratory services provided by approved laboratory facilities that receive payment on a Fee-for-Service (FFS) basis to beneficiaries enrolled within Medical Services Plan (MSP).
The Laboratory Services Outpatient Payment Schedule consists of the Preamble and a Schedule of Fees. (Note: If there is an inadvertent conflict between the fee item description in the Schedule of Fees and information in the Preamble, the interpretation in the Schedule of Fees shall prevail.)
The preamble complements the Schedule of Fees, providing notes within each section by sub discipline. It assists operators in billing for insured outpatient laboratory services.
The preamble includes
- an introduction for operators of approved laboratory facilities
- a facility operations administration chapter with billing and payment procedures, recordkeeping requirements, and service provisions
- an introduction to laboratory services and fees for operators
- information for referring practitioners, including limits and conditions on certain laboratory tests and services
- glossary of terms
- the Payment Schedule index of amendments
Preamble to the Laboratory Services Outpatient Payment Schedule
The Outpatient Payment Schedule is approved by the Minister of Health and functions as the primary claim processing and payments policy document for insured FFS outpatient laboratory services in BC. It contains billing and payment detail for laboratory operators and a schedule of laboratory medicine fees, as well as limits regarding tests ordered by referring healthcare practitioners.
The Schedule provides fee item information by discipline, and includes fee item codes, test descriptions, test limits and conditions (notes), and reimbursement value.
Section 1 - Hematology and Blood Bank
Section 2- Microbiology
Section 3 - Chemistry
Section 4 - Cytogenetics
Section 5 - Virology
Section 6 - Anatomic Pathology
Section 7 - Other
As of April 1, 2019, BC’s Agency for Pathology and Laboratory Medicine, under the Provincial Health Services Authority, maintains the Outpatient Payment Schedule. The schedule is reviewed and updated as required based on best evidence and in consultation with stakeholders.
Laboratory Services Outpatient Payment Schedule
The Ministry applies a lab volume discounting model to outpatient laboratory services reimbursed on a FFS basis. It is based on a comparison to the 2011/2012 volumes for 56 specified fee items. Under this model
- 62% of the 2011/2012 volumes for the specified tests are reimbursed at 100% of the published fee
- where volumes of these tests exceed 62%, reimbursement is discounted to 50% of the published fee
The following schedule of fee items are subject to laboratory volume discounting:
Outpatient Fee Items Subject to Laboratory Volume Discounting