evekhm/cms_iom_500 huggingface dataset:
(Medicare Claims Processing Manual)
40.7 - Billing for Noncovered Clinical Laboratory Tests  (Rev. 1, 10-01-03) B3-5114.1  Ordinarily, neither a physician nor a laboratory bills the Medicare Program for noncovered tests.  However, if the beneficiary (or his/her representative) contends that a clinical laboratory test which a physician or laboratory believes is noncovered may be covered, the physician or laboratory must file a claim that includes the test to effectuate the beneficiarys right to a Medicare determination.  The physician or laboratory annotates the claim that he/she believes that the test is noncovered and is submitting it at the beneficiarys insistence.  Before furnishing a beneficiary a test which the physician or laboratory believes is excluded from coverage as not reasonable and necessary (rather than excluded from coverage as part of a routine physical check -up), the physician or laboratory must obtain a signed Advanced Benefici ary Notice (ABN) from the beneficiary (or representative) that the physician or laboratory has informed him/her of the noncoverage of the test and that there will be a charge for the test.  This protects the physician or laboratory against possible liability for the test under the limitation of liability provision.   See Chapter 30, regarding Advance Beneficiary Notices (ABN) and demand bills.  40.8 - Date of Service (DOS) for Clinical Laboratory and Pathology Specimens  (Rev. 4481; Issued: 12- 20-19, Effective: 01-01-20, Implementation: 01-23-20)  The DOS policy for either a clinical laboratory test or the technical component of physician pathology service is as follows:   General Rule:  The DOS of the test/service must be the date the specimen was collected.   Variation : If a specimen is collected over a period that spans two calendar days, then the DOS must be the date the collection ended.   Exceptions: The following three exceptions apply to the DOS policy for either a clinical laboratory test or the technical component of physician pathology service:  A. DOS for Tests/Services Performed on Stored  Specimens:   In the case of a test/service performed on a stored specimen, if a specimen was stored for less than or equal to 30 calendar days from the date it was collected, the DOS of the test/service must be the date the test/service was performed only if:
(Medicare Claims Processing Manual)
 The test/service is ordered by the patients physician at least 14 days following the date of the patients discharge from the hospital;   The specimen was collected while the patient was undergoing a hospital surgical procedure;   It would be medically inappropriate to have collected the sample other than during the hospital procedure for which the patient was admitted;    The results of the test/service do not guide treatment provided during the hospital stay; and   The test/service was reasonable and medically necessary for treatment of an  illness.   If the specimen was stored for more than 30 calendar days before testing, the specimen is considered to have been archived and the DOS of the test/service must be the date the specimen was obtained from storage.   B. DOS for Chemotherapy Sensitivity Tests/Services Performed on Live Tissue:   In the case of a chemotherapy sensitivity test/service performed on live tissue, the DOS of the test/service must be the date the test/service was performed only if:    The decision regarding the specific chemotherapeutic agents to test is made at least 14 days after discharge;    The specimen was collected while the patient was undergoing a hospital surgical  procedure;    It would be medically inappropriate to have collected the sample other than during the hospital procedure for which the patient was  admitted;    The results of the test/service do not guide treatment provided during the hospital stay;  and   The test/service was reasonable and medically necessary for treatment of an  illness.   For purposes of applying the above exception, a chemotherapy sensitivity test is defined as a test that requires a fresh tissue sample to test the sensitivity of tumor cells to various chemotherapeutic agents. CMS identifies such tests through program instructions issued to the Medicare Administrative Contractors (MACs).   C. DOS for Advanced Diagnostic Laboratory Tests and Molecular Pathology Tests:   In the case of a molecular pathology test performed by a laboratory other than a blood bank or center, or a test designated by CMS as an ADLT under paragraph (1) of the definition of advanced diagnostic laboratory test in 42 CFR 414.502, the DOS must be the date the test was performed only if:    The test was performed following a hospital outpatients discharge from the        hospital  outpatient department;    The specimen was collected from a hospital outpatient during an encounter                      (as both are defined in 42 CFR  410.2);
(Medicare Claims Processing Manual)
 The test was performed following a hospital outpatients discharge from the        hospital  outpatient department;    The specimen was collected from a hospital outpatient during an encounter                      (as both are defined in 42 CFR  410.2);    It was medically appropriate to have collected the sample from the hospital outpatient during the hospital outpatient encounter;    The results of the test do not guide treatment provided during the hospital outpatient  encounter; and   The test was reasonable and medically necessary for the treatment of an  illness.   For the purpose of section 40.8.C, a  blood bank or center means an entity whose primary function is the performance or responsibility for the performance of, the collection, processing, testing, storage and/or distribution of blood or blood components intended for transfusion and transplantation.    50 - A/B MAC (B)  Claims Processing  (Rev. 1, 10- 01-03)  50.1 - Referring Laboratories  (Rev. 85, 02- 06-04) B3-5114.1  Medicare recognizes that specimens drawn or collected by one laboratory are sometimes referred to another laboratory for testing.  Payment for a Medicare -covered, referred laboratory service may be made under the rules established in Chapter 15 40.1.  The rules specified Chapter 15 40.1 do not apply to services performed in a physician office laboratory or a qualified hospital laboratory.  Both circumstances are entirely outside the scope of all sections concerning referral laboratory services.
(Medicare Claims Processing Manual)
Every A/B MAC (B) shall process a claim for a referred laboratory service if submitted by an independent clinical laboratory with a physical presence within the A/B MAC (B)s jurisdiction, notwithstanding that the referred laboratory service may have been performed outside of its jurisdiction.  Every A/B MAC (B) shall maintain the clinical laboratory fee schedules for each A/B MAC (B) jurisdiction and be able to process claims using those fee schedules.  Every A/B MAC (B) shall base payment for a referred service on the fee schedule for the jurisdiction in which the service was performed, i.e., where the test was performed.  An exception to this rule allows a payment for a service that is A/B MAC (B) -priced to be based upon the price developed by the A/B MAC (B) processing the claim.  Every A/B MAC (B) that has previously assigned reference use only PINs to out -of-jurisdiction laboratories for the purpose of their billing referred services shall cancel such reference -use-only PINs.  A/B MACs (B) must use the numerical locality codes specified in 50.4 to identify the appropriate clinical diagnostic laboratory fee schedule for use in pricing a referred laboratory service.   50.2 - Physicians (Rev. 1, 10- 01-03) B3-4110.2  If a physician or medical group furnishes laboratory tests in an office setting and it is appropriate for them to be performed in the physicians office, no further development of the source of the laboratory tests is required.
(Medicare Claims Processing Manual)
If a physician or medical group furnishes laboratory tests in an office setting and it is appropriate for them to be performed in the physicians office, no further development of the source of the laboratory tests is required.   If a claim or physicians bill raises a question as to the source of a laboratory test and it cannot be resolved from available information, A/B MACs (B) must request the source of the laboratory service from the physician.  If the clinical laboratory test is subject to the laboratory fee schedule, A/B MACs (B) must pay only the person or entity that performed or supervised the performance of the test.  However, A/B MACs (B) may also pay one physician for tests performed or supervised by another physician with whom he/she shares a practice, i.e., the two physicians are members of a medical group whose physicians submit claims in their own names rat her than in the name of the group.  Where the medical group submits claims in the name of the group for the services of the physician who performed or supervised the performance of these tests, A/B MACs (B) must pay the group.  Regardless of who submits th e claim, assignment is required for payment.  See 50.2.1 below.  50.2.1 - Assignment Required  (Rev.  3510, Issued: 04- 29-16, Effective: 10-01- 16, Implementation; 10-03-16)   Carriers must:   Pay for clinical laboratory services provided in the physicians office only on an assignment basis.   Treat as assigned any claims for clinical laboratory services provided in the physicians office even if the claimant submits the claim on a non- assigned basis or if the assignment option is not designated.   Deny claims where it is apparent from the claims form or from other evidence that the beneficiary or provider refuses to assign.    The contractor shall use the following remittance advice message and associated codes when rejecting/denying claims under this policy.  This CARC/RARC combination is compliant with CAQH CORE Business Scenario Three.  Group Code: CO or PR CARC: 111  RARC: N/A  MSN: 16.41 OR 16.6  50.3 - Hospitals  (Rev. 1, 10-01-03)  50.3.1 - Hospital -Leased Laboratories  (Rev. 1, 10-01-03) B3-4110.1
(Medicare Claims Processing Manual)
A/B MACs (B) process claims from hospital laboratories that are leased by physicians and independent laboratories.  Before processing claims for services furnished by a hospital laboratory department operated on a lease or concession basis by a pathologist or by a nonphysician specialist such as a biochemist (with a visiting pathologist or outside independent laboratory doing the hospitals tissue work), A/B MACs (B) must ascertain if the laboratory ha s been approved by the RO.  Services furnished by a laboratory that does not meet the hospital laboratory conditions of participation and is operated under a lease arrangement in a domestic emergency hospital are covered only if they are emergency inpatient services payable under Par t A.  Additional information concerning nonparticipating emergency hospital services is found in Chapter 3.  50.3.2 - Hospital Laboratory Services Furnished to Nonhospital Patients  (Rev. 3014, Issued: 08- 06-14, Effective: ICD - 10: Upon Implementation of ICD -10 ASC- X12: 01- 01-12, Implementation: ICD -10: Upon Implementation of ICD -10 ASC X12: 09 -08-14)  When a hospital laboratory performs a laboratory service for a non- hospital patient, (i.e., for neither an inpatient nor an outpatient), the hospital bills its A/B MAC (A) on the ASC X12 837 institutional claim format or on the hard copy Form CMS -1450.  If  an A/B MAC (B) receives such claims, the A/B MAC (B) should deny them.  When the lab services are provided in Maryland, services to a hospitals own outpatients are paid under the State cost containment system.  A Maryland hospital cannot seek payment bas ed on a percent of charges for tests provided to individuals in locations such as a rural health clinic (RHC), a provider -based HHA, the individuals home or a physicians office).  Individuals in these locations are non- patients of the Maryland hospital a nd their lab tests would be categorized as non -patient specimen only lab tests (TOB 14x), and are paid under the lab fee schedule.   When a hospital -leased laboratory performs a service for a non -hospital patient, it must bill the A/B MAC (B).
(Medicare Claims Processing Manual)
When a hospital -leased laboratory performs a service for a non -hospital patient, it must bill the A/B MAC (B).   50.4 - Reporting of Pricing Localities for Clinical Laboratory Services  (Rev.  3875, Issued: 10- 06-17, Effective: 01 -08-18, Implementation: 01- 08-18) PM-B-97-12  A/B MACs (B) shall report to the common working file (CWF) new State pricing localities (positions 58 and 59 on the A/B MAC (B) record) indicated on the Clinical Diagnostic Laboratory fee schedule for any reference laboratory service billed with a HCPCS 90  modifier.  If the laboratory test billed is not a reference laboratory service, the A/B MAC (B) Locality (location 11 -12) on the Clinical Diagnostic Laboratory fee schedule should be forwarded to the CWF.  For dates of service on or after April 1, 2004, CWF will not edit clinical laboratory pricing locality.   The A/B MAC (A) and (B) record layouts, plus the State pricing locations are as follows:   A/B MAC (B) RECORD LAYOUT FOR DATA FILE  CLINICAL LABORATORY FEE SCHEDULE  Data Element Name  Picture  Location  Comment  HCPCS Code  X(05)  1-5  Data Element Name  Picture  Location  Comment  A/B MAC (B) Number  X(05)  6-10  A/B MAC (B) Lo  X(02)  11-12 00--Single State A/B MAC (B)  01--North Dakota  02--South Dakota  02--South Dakota  20--Puerto Rico  60% Local Fee 9(05)V99  13-19  62% Local Fee  9(05)V99  20-26  60% Natl Limit Amt  9(05)V99  27-33  62% Natl Limit Amt  9(05)V99  34-40  60% Pricing Amt  9(05)V99  41-47  62% Pricing Amt  9(05)V99  48-54  Gap-Fill Indicator  X(01)  55-55 0  No Gap -fill Required  1-- A/B MAC (B) Gap -fill 2--Special Instructions Apply  Modifier  X(02)  56-57 Where modifier is shown, QW denotes  a CLIA waiver test  State Locality  X(02)  58-59 See attached  FILLER  X(01)  60
(Medicare Claims Processing Manual)
A/B MAC (A) RECORD LAYOUT FOR DATA FILE  CLINICAL LABORATORY FEE SCHEDULE  Data Element Name  Picture  Location  Comment  HCPCS  X(05)  1-5  Filler  X(04)  6-9  60% Pricing Amt  9(05)V99  10-16  62% Pricing Amt  9(05)V99  17-23  Filler  X(07)  24-30  A/B MAC (B) Number  X(05)  31-35  Data Element Name  Picture  Location  Comment  A/B MAC (B) Locality  X(02)  36-37 00--Single State A/B MAC (B)  01--North Dakota  02--South Dakota  20  Puerto Rico  State Locality  X(02)  38-39 See Attached  FILLER  X(21)  40-60   On or after January 1, 2018, t he record layouts  of the CLFS are as follows:    Data Element Name  Picture  Location  Comment  Year  PIC X(04)  1-4 Calendar year (YYYY) associated with the Clinical Lab Fee Schedule.  Filler  PIC X(01)  5 Value ' '  HCPCS Code  PIC X(05)  6-10 All current year active CPT and alpha -numeric codes subject to CLFS. Filler  PIC X(01)  11 Value ' '  Modifier  PIC X(02)  12-13 Where modifier is shown, QW denotes a CLIA waiver test.  Filler  PIC X(01)  14 Value ' '  Effective Date  PIC X(08)  15-22 Date the Clinical Lab Fee Schedule became effective (YYYYMMDD).  Filler  PIC X(01)  23 Value ' '  Indicator  PIC X(01)  24 National (N) or Local (L) payment indicator.  Filler  PIC X(01)  25 Value ' '  Payment Rate PIC Z9(05)V99  26-32 The payment amount associated with each test on the Clinical Lab Fee Schedule.  Filler  PIC X(01)  33 Value ' '  Description  PIC X(40)  34-73 Short description of the applicable HCPCS code.      CarrierLocality/StateLocality Map
(Medicare Claims Processing Manual)
Carrier/Loc 1010200 =State Loc 01 (ALABAMA)  Carrier/Loc 0210201 =State Loc 02 (ALASKA)  Carrier/Loc 0310200 =State Loc 04 (ARIZONA)  Carrier/Loc 0710213 =State Loc 05 (ARKANSAS)  Carrier/Loc 0118218 =State Loc 06 (CALIFORNIA)  Carrier/Loc 0118226 =State Loc 06 (CALIFORNIA)  Carrier/Loc 0111252 =State Loc 06 (CALIFORNIA)  Carrier/Loc 0111207 =State Loc 06 (CALIFORNIA)  Carrier/Loc 0111205 =State Loc 06 (CALIFORNIA)  Carrier/Loc 0111206 =State Loc 06 (CALIFORNIA)  Carrier/Loc 0111209 =State Loc 06 (CALIFORNIA)  Carrier/Loc 0111251 =State Loc 06 (CALIFORNIA)  Carrier/Loc 0111253 =State Loc 06 (CALIFORNIA)  Carrier/Loc 0111254 =State Loc 06 (CALIFORNIA)  Carrier/Loc 0111255 =State Loc 06 (CALIFORNIA)  Carrier/Loc 0111256 =State Loc 06 (CALIFORNIA)  Carrier/Loc 0111257 =State Loc 06 (CALIFORNIA)  Carrier/Loc 0111258 =State Loc 06 (CALIFORNIA)  Carrier/Loc 0111259 =State Loc 06 (CALIFORNIA)  Carrier/Loc 0111260 =State Loc 06 (CALIFORNIA)  Carrier/Loc 0111261 =State Loc 06 (CALIFORNIA)  Carrier/Loc 0111262 =State Loc 06 (CALIFORNIA)  Carrier/Loc 0111263 =State Loc 06 (CALIFORNIA)  Carrier/Loc 0111264 =State Loc 06 (CALIFORNIA)  Carrier/Loc 0111265 =State Loc 06 (CALIFORNIA)  Carrier/Loc 0111266 =State Loc 06 (CALIFORNIA)  Carrier/Loc 0111267 =State Loc 06 (CALIFORNIA)  Carrier/Loc 0111268 =State Loc 06 (CALIFORNIA)  Carrier/Loc 0111269 =State Loc 06 (CALIFORNIA)  Carrier/Loc 0111270 =State Loc 06 (CALIFORNIA)  Carrier/Loc 0118271 =State Loc 06 (CALIFORNIA)  Carrier/Loc
(Medicare Claims Processing Manual)
0111269 =State Loc 06 (CALIFORNIA)  Carrier/Loc 0111270 =State Loc 06 (CALIFORNIA)  Carrier/Loc 0118271 =State Loc 06 (CALIFORNIA)  Carrier/Loc 0118272 =State Loc 06 (CALIFORNIA)  Carrier/Loc 0118273 =State Loc 06 (CALIFORNIA)  Carrier/Loc 0118274 =State Loc 06 (CALIFORNIA)  Carrier/Loc 0118217 =State Loc 06 (CALIFORNIA)  Carrier/Loc 0111275 =State Loc 06 (CALIFORNIA)  Carrier/Loc 0411201 =State Loc 08 (COLORADO)  Carrier/Loc 1310200 =State Loc 09 (CONNECTICUT)  Carrier/Loc 1210201 =State Loc 10 (DELAWARE)  Carrier/Loc 1220201 =State Loc 11 (DISTRICT OF COLUMBIA)  Carrier/Loc 0910203 =State Loc 12 (FLORIDA)  Carrier/Loc 0910204 =State Loc 12 (FLORIDA)  Carrier/Loc 0910299 =State Loc 12 (FLORIDA)  Carrier/Loc 1020201 =State Loc 13 (GEORGIA)  Carrier/Loc 1020299 =State Loc 13 (GEORGIA)  Carrier/Loc 0121201 =State Loc 15 (HAWAII/GUAM)  Carrier/Loc 0220200 =State Loc 16 (IDAHO)  Carrier/Loc 0610216 =State Loc 17 (ILLINOIS)  Carrier/Loc 0610212 =State Loc 17 (ILLINOIS)  Carrier/Loc 0610215 =State Loc 17 (ILLINOIS)  Carrier/Loc 0610299 =State Loc 17 (ILLINOIS)  Carrier/Loc 0810200 =State Loc 18 (INDIANA)  Carrier/Loc 0510200 =State Loc 19 (IOWA)  Carrier/Loc 0520200 =State Loc 20 (KANSAS)  Carrier/Loc 1510200 =State Loc 21 (KENTUCKY)  Carrier/Loc 0720201 =State Loc 22 (LOUISIANA)  Carrier/Loc 0720299 =State Loc 22 (LOUISIANA)  Carrier/Loc 1411203 =State Loc 23 (MAINE)  Carrier/Loc 1411299 =State Loc 23 (MAINE)  Carrier/Loc 1230201 =State
(Medicare Claims Processing Manual)
=State Loc 22 (LOUISIANA)  Carrier/Loc 1411203 =State Loc 23 (MAINE)  Carrier/Loc 1411299 =State Loc 23 (MAINE)  Carrier/Loc 1230201 =State Loc 24 (MARYLAND)  Carrier/Loc 1230299 =State Loc 24 (MARYLAND)  Carrier/Loc 1421201 =State Loc 25 (MASSACHUSETTS)  Carrier/Loc 1421299 =State Loc 25 (MASSACHUSETTS)  Carrier/Loc 0820201 =State Loc 26 (MICHIGAN)  Carrier/Loc 0820299 =State Loc 26 (MICHIGAN)  Carrier/Loc 0620200 =State Loc 27 (MINNESOTA)  Carrier/Loc 0730200 =State Loc 28 (MISSISSIPPI)  Carrier/Loc 0530202 =State Loc 29 (MISSOURI)  Carrier/Loc 0530201 =State Loc 29 (MISSOURI)  Carrier/Loc 0530299 =State Loc 29 (MISSOURI)  Carrier/Loc 0320201 =State Loc 30 (MONTANA)  Carrier/Loc 0540200 =State Loc 31 (NEBRASKA)  Carrier/Loc 0131200 =State Loc 32 (NEVADA)  Carrier/Loc 1431240 =State Loc 33 (NEW HAMPSHIRE)  Carrier/Loc 1240201 =State Loc 34 (NEW JERSEY)  Carrier/Loc 1240299 =State Loc 34 (NEW JERSEY)  Carrier/Loc 0421205 =State Loc 35 (NEW MEXICO)  Carrier/Loc 1320201 =State Loc 36 (NEW YORK)  Carrier/Loc 1320202 =State Loc 36 (NEW YORK)  Carrier/Loc 1320203 =State Loc 36 (NEW YORK)  Carrier/Loc 1329204 =State Loc 36 (NEW YORK)  Carrier/Loc 1328299 =State Loc 36 (NEW YORK)  Carrier/Loc 1150200 =State Loc 37 (NORTH CAROLINA)  Carrier/Loc 0330201 =State Loc 38 (NORTH DAKOTA)  Carrier/Loc 1520200 =State Loc 39 (OHIO)  Carrier/Loc 0431200 =State Loc 40 (OKLAHOMA)  Carrier/Loc 0230201 =State Loc 41 (OREGON)  Carrier/Loc 0230299 =State
(Medicare Claims Processing Manual)
=State Loc 39 (OHIO)  Carrier/Loc 0431200 =State Loc 40 (OKLAHOMA)  Carrier/Loc 0230201 =State Loc 41 (OREGON)  Carrier/Loc 0230299 =State Loc 41 (OREGON)  Carrier/Loc 1250201 =State Loc 42 (PENNSYLVANIA)  Carrier/Loc 1250299 =State Loc 42 (PENNSYLVANIA)  Carrier/Loc 0920220 =State Loc 72 (PUERTO RICO)  Carrier/Loc 1441201 =State Loc 44 (RHODE ISLAND)  Carrier/Loc 1120201 =State Loc 45 (SOUTH CAROLINA)  Carrier/Loc 0340202 =State Loc 46 (SOUTH DAKOTA)  Carrier/Loc 1030235 =State Loc 47 (TENNESSEE)  Carrier/Loc 0441231 =State Loc 48 (TEXAS)  Carrier/Loc 0441220 =State Loc 48 (TEXAS)  Carrier/Loc 0441209 =State Loc 48 (TEXAS)  Carrier/Loc 0441211 =State Loc 48 (TEXAS)  Carrier/Loc 0441228 =State Loc 48 (TEXAS)  Carrier/Loc 0441215 =State Loc 48 (TEXAS) Carrier/Loc 0441218 =State Loc 48 (TEXAS) Carrier/Loc 0441299 =State Loc 48 (TEXAS) Carrier/Loc 0350209 =State Loc 49 (UTAH) Carrier/Loc 1451250 =State Loc 50 (VERMONT) Carrier/Loc 0920250 =State Loc 78 (VIRGIN ISLANDS) Carrier/Loc 1130200 =State Loc 51 (VIRGINIA) Carrier/Loc 0240202 =State Loc 53 (WASHINGTON) Carrier/Loc 0240299 =State Loc 53 (WASHINGTON) Carrier/Loc 1140216 =State Loc 54 (WEST VIRGINIA) Carrier/Loc 0630200 =State Loc 55 (WISCONSIN) Carrier/Loc 0360221 =State Loc 56 (WYOMING)  50.5 - Jurisdiction of Laboratory Claims (Rev. 3071, Issued: 09- 19-14, Effective: 12-22-14, Implementation: 12-22-14)
(Medicare Claims Processing Manual)
Jurisdiction of payment requests for laboratory services furnished by an independent laboratory, except where indicated in 50.5.1 and 50.5.2, lies with the A/B MAC (B) serving the area in which the laboratory test is performed.  Jurisdiction is not affected by whether or not the independent laboratory uses a central billing office and whether or not the laboratory provides services to customer s outside its A/B MAC (B)s service area.  The location where the independent laboratory performed the test determines the 50.appropriate billing jurisdiction.  Therefore, even if the sample originates in a different jurisdiction from where the sample is being tested, the claim would still be filed in the jurisdiction where the test was performed.   Claims filing jurisdiction for the specimen collection fee and travel allowance is also determined by the location where the test was performed.  When billed by an independent lab, the specimen collection fee and travel allowance must be billed in conjunction with a covered lab test.  For more information about the specimen collection fee and travel allowance, see 60.1 and 60.2, respectively.  50.5.1 - Jurisdiction Of Referral Laboratory Services  (Rev. 85, 02-06-04)  Regardless of whether the laboratory that bills Medicare is the referring or reference laboratory, the laboratory that does the billing may bill only the A/B MAC (B) that services the jurisdiction in which the billing laboratory is physically located.  The location of the draw station, when a separate draw station is employed, never determines claims filing jurisdiction.   50.5.2 - Examples of Reference Laboratory Jurisdiction Rules  (Rev. 85, 02-06-04) B3-3102  EXAMPLE 1:   Scenario 1:   An independent laboratory located in Oregon performs laboratory services for physicians whose offices are located in several neighboring States.  A physician from Nevada sends specimens to the Oregon laboratory.   Jurisdiction:  The A/B MAC (B) in Oregon has jurisdiction.   EXAMPLE 2:   Scenario 2:  American Laboratories, Inc., is an independent laboratory company with branch laboratories located in Philadelphia, PA and Wilmington, DE, as well as regional laboratories located in Millville, NJ and Boston, MA.  The Philadelphia laboratory receives a blood sample from a patient whose physician ordered a complete blood count, a basic metabolic panel and a B12 and folate.  The Philadelphia laboratory performs the complete blood count, but the basic metabolic panel is performed at the Millville laboratory, while the B12 and folate is performed at the Boston Laboratory.