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, record-keeping 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 (PDF)

The Laboratory Services Outpatient Payment Schedule (PDF) contains billing and payment details for laboratory operators, and a schedule of laboratory medicine fees organized by discipline, including fee item codes, test descriptions, limits and conditions regarding tests ordered by health practitioners, 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, PHSA maintains the Laboratory Services 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 (PDF)

This is a summary of the Laboratory Services Act Records of Decision related to the Laboratory Services Outpatient Payment Schedule:

• Records of Decision Summary - Laboratory Services Outpatient Payment Schedule (PDF)

The operator payment administration (OPA) process facilitates the payment of fee-for-service claims made by approved laboratory operators. Both the referring practitioner and the laboratory operator must complete and authorize the OPA process (PDF) before PLMS can process claims.

For more information see the Operator Payment Administration User Guide (PDF).

The Ministry of Health applies a lab volume discounting model to outpatient laboratory services reimbursed on a FFS basis. It is based on a comparison to the 2011/12 volumes for 56 specified fee items. Under this model:

• 62% of the 2011/12 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 (PDF)

‎The Minister approves any additions, deletions or other changes to the Laboratory Services Outpatient Payment Schedule or to individual fees, following a consultative process.

If advances in technology, for example, result in the use of a different platform methodology for existing approved tests, you must submit an application for a new or amended fee item in accordance with PLMS’s test review process.‎

‎Under section 4 (1) of the LSA, a laboratory service is a benefit if it is a medically required service provided through an approved laboratory facility. For the purposes of this Payment Schedule, a laboratory facility means:

1. that part of a hospital that provides outpatient laboratory services;
2. a facility that provides outpatient laboratory services; or
3. a specimen collection station associated with a hospital or facility.

Services rendered to hospital inpatients, “day surgery” patients, or emergency department patients are not payable under this Payment Schedule.‎

‎All tests that are medically necessary but not available in B.C. can be referred to the OOP/OOC program at the PLMS for funding decisions. For more information, see Out of Province & Out of Country Funding Program.‎