CurrentPartners Insurance Company dba Jefferson Health PlansPolicy RB.006.D

STAT Laboratory Services Reimbursement

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This policy governs reimbursement for STAT laboratory tests needed immediately to manage or prevent medical emergencies. It applies to participating providers across Jefferson Health Plans lines of business, subject to applicable benefits, contracts, and plan-specific payment terms.

Policy Summary

PayerPartners Insurance Company dba Jefferson Health Plans

PolicySTAT Laboratory Services Reimbursement

Policy CodePolicy RB.006.D

Change TypeGuideline updateno material coverage change

Effective DateN/A

Last ReviewAug 13, 2025

Next Review DateN/A

Key ActionReport modifier ET and indicate STAT on the claim for eligible STAT laboratory services.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

All linesPolicy applicability

Not requiredPrior authorization

ETRequired modifier

Lab charge onlyPayment limitation

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CurrentPartners Insurance Company dba Jefferson Health PlansPolicy RB.006.D

STAT Laboratory Services Reimbursement

Customize your policy alerts

Sign up for partners_insurance_company_dba_jefferson_health_plans Policy RB.006.D alerts

Get alerted when Policy RB.006.D changes without checking for updates manually.

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Policy Summary

PayerPartners Insurance Company dba Jefferson Health Plans

PolicySTAT Laboratory Services Reimbursement

Policy CodePolicy RB.006.D

Change TypeGuideline updateno material coverage change

Effective DateN/A

Last ReviewAug 13, 2025

Next Review DateN/A

Key ActionReport modifier ET and indicate STAT on the claim for eligible STAT laboratory services.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

All linesPolicy applicability

Not requiredPrior authorization

ETRequired modifier

Lab charge onlyPayment limitation

STAT Laboratory Reimbursement Criteria

Reimbursement is available for STAT laboratory services when all applicable criteria are satisfied.

ALL of the following

Test results are needed immediately to manage a medical emergency or prevent a potential medical emergency.
The STAT laboratory service is ordered by a participating professional provider.
The provider reports modifier ET and reports STAT on the claim form.
The claim diagnosis supports the urgency of each STAT laboratory service billed.
Appropriate supporting documentation is retained and provided upon request.
For office-based services, the provider is contracted to perform the laboratory service and bills according to plan policy.
Payment is made for the laboratory charge only; STAT fee charges are not reimbursed.

Required Coding

Required STAT laboratory modifierModifier

ET	Modifier required when performing STAT laboratory services

Billing and Documentation Requirements

Prior Authorization

Prior Authorization Not Required

Prior authorization is not required for STAT laboratory services.

Billing Rule

Eligible Ordering Provider

STAT laboratory services must be ordered by a participating professional provider authorized to order them, such as a primary care physician or specialist.

The ordering provider must participate with Jefferson Health Plans.

Policy Summary

PayerPartners Insurance Company dba Jefferson Health Plans

PolicySTAT Laboratory Services Reimbursement

Policy CodePolicy RB.006.D

Change TypeGuideline updateno material coverage change

Effective DateN/A

Last ReviewAug 13, 2025

Next Review DateN/A

Key ActionReport modifier ET and indicate STAT on the claim for eligible STAT laboratory services.

SourceLink

On This Page

Documentation Required

Retain Supporting Documentation

Keep appropriate supporting documentation on file for all STAT laboratory services and present it to Jefferson Health Plans upon request.

Documentation must be retained and produced when requested.

Billing Rule

Office-Based STAT Laboratory Services

Providers may be reimbursed for STAT laboratory services performed in the office only when the provider is contracted to perform those services and the services are billed according to Plan policy.

Report “STAT” on the claim form for the STAT laboratory service.
Payment is made for the laboratory charge only; separate STAT fee charges are not reimbursed.

Billing Rule

Participating Laboratory Requirements

Outpatient laboratory services must be obtained from Quest Diagnostics, Health Network Laboratories (HNL), or hospital locations contracted to provide laboratory services. Participating laboratory locations are available through the Jefferson Health Plans Healthcare Provider Directory.

Physicians must complete the requisition form for all laboratory services.
Laboratories must be CLIA-approved for participation in the Medical Assistance Program.