2023 Tennessee Code › Title 56 - INSURANCE (§§ 56-1-101 — 56-61-125) › Chapter 7 - POLICIES AND POLICYHOLDERS 33|373 (§§ 56-7-NEW — 56-7-3722) › Part 10 - HEALTH AND ACCIDENT INSURANCE (§§ 56-7-NEW — 56-7-1019) › Section 56-7-1015 - Reimbursement for anatomic pathology services

(a)
No patient, insurer, or third party payor shall be required to reimburse any licensed practitioner for charges or claims submitted in violation of this part.
(b)
A clinical laboratory or physician, located in this state, or in another state, providing anatomic pathology services for patients in this state, shall present or cause to be presented a claim, bill or demand for payment for these services only to the following:
(1)
The patient directly;
(2)
The responsible insurer or other third-party payor;
(3)
The hospital, public health clinic, or nonprofit health clinic ordering such services;
(4)
The referring laboratory or a referring physician; provided, that:
(A)
A physician in the referring laboratory is performing or supervising the professional component of the anatomic pathology service for the patient; or
(B)
A referring physician has provided a written confirmation to the physician or laboratory providing the anatomic pathology service that the patient is not covered under any health care benefit program;
(5)
Governmental agencies and/or their specified public or private agent, agency, or organization on behalf of the recipient of the services.
(c)
Except for a physician billing for a referring laboratory's services pursuant to subsection (g) or (h), no licensed practitioner in the state shall, directly or indirectly, charge, bill, or otherwise solicit payment for anatomic pathology services unless such services were rendered personally by the licensed practitioner or under the licensed practitioner's direct supervision in accordance with § 353 of the Public Health Service Act (
42 U.S.C. § 263a
).
(d)
Nothing in this section shall be construed to mandate the assignment of benefits for anatomic pathology services as defined in this section or payment for anatomic pathology services under this section, or under any health care benefit program, to any practitioner or physician exempted from this section.
(e)
For purposes of this section, "anatomic pathology services" means:
(1)
Histopathology or surgical pathology, meaning the microscopic examination (professional component) and histologic processing of organ tissue (technical component) performed by a physician or under the supervision of a physician;
(2)
Cytopathology, meaning the microscopic examination of cells from the following:
(A)
Fluids;
(B)
Aspirates;
(C)
Washings;
(D)
Brushings; or
(E)
Smears, including the Pap test examination performed by a physician or under the supervision of a physician;
(3)
Hematology, meaning the microscopic evaluation of bone marrow aspirates and biopsies performed by a physician, or under the supervision of a physician, and peripheral blood smears when the attending or treating physician, or technologist requests that a blood smear be reviewed by a pathologist;
(4)
Sub-cellular pathology or molecular pathology, meaning the assessment of a patient specimen for the detection, localization, measurement, or analysis of one or more protein or nucleic acid targets;
(5)
Blood-banking services performed by pathologists.
(f)
For purposes of the section, "health care benefit program" means any group or individual insurance or health maintenance policy or contract, whether public or private, which provides benefits for medical items or services.
(g)
A referring physician may bill a patient not covered under a health care benefit program for an anatomic pathology service if the referring physician was billed pursuant to §
56-7-1015(b)(4)
; provided, that the referring physician complies with the disclosure requirement of §
63-6-214(b)(22)
or §
63-9-111(b)(22)
and does not, directly or indirectly, markup or increase the actual amount billed by the physician or clinical laboratory that performed the anatomic pathology service.
(h)
This section does not prohibit a laboratory, physician, physician's office or group practice directly performing the professional component of the anatomic pathology service from billing for a referring laboratory's services in instances where a sample or samples must be sent to another physician or laboratory for consultation or histologic processing. For purposes of this subsection (h), "referring laboratory" means a laboratory that performs histologic processing or consultation on an anatomic pathology specimen.
(i)
Nothing in this section shall be construed to mandate the billing of any patient not covered under a health care benefit program, or any referring physician who has ordered an anatomic pathology service for a patient not covered under a health care benefit program.
(j)
Nothing in this section shall apply to anatomic pathology services billed by gastroenterologists on patients in this state until July 1, 2014.
(k)
The respective state licensing boards having jurisdiction over any practitioner who may request or provide anatomic pathology services may revoke, suspend or deny renewal of the license of any practitioner who violates this section.
Acts 2010 , ch. 952, § 1.