HB 12-1221 Summary

• Clinical laboratories and physicians providing anatomic pathology services in Colorado must bill only the patient, insurance carrier, ordering hospital/clinic, referring laboratory, or government agency—not other practitioners.

• Licensed practitioners cannot charge for anatomic pathology services unless they personally rendered the services or directly supervised them in compliance with federal law (42 U.S.C. § 263a).

• Patients, insurers, hospitals, and clinics are not required to reimburse practitioners for charges submitted in violation of these billing restrictions.

• Group practices may bill for anatomic pathology services when a physician in the group performs or supervises services in a laboratory owned and operated by at least one group member.

• Anatomic pathology services include histopathology, cytopathology, hematology, molecular pathology, and blood-banking services; violators are subject to civil action to recover amounts paid.