(005010X222) Is it compliant for a payer to ask Providers to send data in SV101-7 outside of the Situational rule?
(005010X223) Is it compliant for a payer to ask Providers to send data in SV202-7 outside of the Situational rule?
Payer Req:
"(005010X222) Each Time a laboratory CPT Code or HCPCS code is populated in the SV101-2 Institutional Service Section, your corresponding test code, prefixed with ""LAB"" should be placed in the SV101-7 Description
(005010X223) Each Time a laboratory CPT Code or HCPCS code is populated in the SV202-2 Institutional Service Section, your corresponding test code, prefixed with ""LAB"" should be placed in the SV202-7 Description"
The situational rules for both SV101-7 and SV202-7 specify that the elements are to be used based on the judgment of the submitter. A payer cannot require a submitter to use these elements. The RFI question refers to the payer asking or requesting this data, a submitter can send it, but a submitter cannot be compelled to send it. If a submitter judges that additional information is needed, the elements may be used to send the information.