HOUSE BILL No. 1071
DIGEST OF INTRODUCED BILL
Citations Affected: IC 16-48.
Synopsis: Anatomic pathology services. Specifies requirements for
billing and claims related to anatomic pathology services.
Effective: July 1, 2011.
January 5, 2011, read first time and referred to Committee on Public Health.
First Regular Session 117th General Assembly (2011)
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HOUSE BILL No. 1071
A BILL FOR AN ACT to amend the Indiana Code concerning
Be it enacted by the General Assembly of the State of Indiana:
SOURCE: IC 16-48; (11)IN1071.1.1. -->
SECTION 1. IC 16-48 IS ADDED TO THE INDIANA CODE AS
ARTICLE TO READ AS FOLLOWS [EFFECTIVE JULY 1,
ARTICLE 48. OTHER HEALTH CARE PROVIDERS AND
Chapter 1. Anatomic Pathology Services
Sec. 1. As used in this chapter, "anatomic pathology service"
means any of the following performed by a physician or under the
supervision of a physician on a sample taken from a human body:
(1) Histopathology or surgical pathology, meaning the gross
and microscopic examination and histologic processing of
(2) Cytopathology, meaning the microscopic examination of
cells from the following:
(3) Hematology, meaning the microscopic evaluation of bone
marrow aspirates and biopsies, and peripheral blood smears
when the attending or treating physician or technologist
requests that a blood smear be reviewed by a pathologist.
(4) Subcellular pathology and molecular pathology, meaning
the assessment of a specimen for detection, localization,
measurement, or analysis of protein or nucleic acid targets.
(5) Blood banking services performed by pathologists.
Sec. 2. As used in this chapter, "referral laboratory" means a
physician or clinical laboratory:
(1) to which a sample is sent by a referring laboratory; and
(2) by which an anatomic pathology service is performed;
for consultation or histologic processing.
Sec. 3. (a) As used in this chapter, "referring laboratory" means
a clinical laboratory that sends a sample to a physician or another
clinical laboratory for performance of an anatomic pathology
service by the physician or other clinical laboratory for
consultation or histologic processing.
(b) The term does not include a physician's office laboratory
that does not perform the professional component of an anatomic
Sec. 4. A health care provider or clinical laboratory that
provides an anatomic pathology service for a patient in Indiana
shall present a bill, claim, or other demand for payment for the
service only to the following:
(1) The patient.
(2) The patient's insurer or other third party payer.
(3) The hospital, health clinic, or other health care provider
that orders the service.
(4) A referring laboratory.
(5) A government agency or other agency or organization
acting on behalf of the patient.
Sec. 5. Except for a health care provider at a referring
laboratory that has been billed by a referral laboratory, a health
care provider shall not solicit payment for an anatomic pathology
service unless the service is rendered personally by the health care
provider or under the health care provider's direct supervision in
accordance with Section 353 of the federal Public Health Service
Act (42 U.S.C. 263a).
Sec. 6. A person is not required to reimburse a health care
provider or clinical laboratory for charges or claims submitted in
violation of this chapter.
Sec. 7. This chapter does not do the following:
(1) Require assignment of benefits for an anatomic pathology
(2) Prohibit billing of a referring laboratory by a referral
Sec. 8. If a health care provider violates this chapter, the state
entity that has jurisdiction over licensing or certification of the
health care provider may revoke, suspend, or refuse to renew the
license or certification of the health care provider.