Health Care Client Alert – New Virginia Law Prohibits Physician Mark-Ups for Anatomic Pathology Services

    By T. Braxton McKee, Laura Dickson Rixey, Health Care

    New Virginia Law Prohibits Physician Mark-Ups for Anatomic Pathology Services

    Effective as of July 1, 2014, Virginia licensed healthcare practitioners are prohibited from marking-up anatomic pathology services performed by independent pathologists. The law is codified as new Section 54.1-2962.01 of the Virginia Code.

    Specifically, Virginia practitioners will no longer be permitted to “charge a fee for anatomic pathology services that is greater than the amount billed to the practitioner for the actual performance of such anatomic pathology services when such services are (i) performed by a person other than the practitioner or (ii) performed by a person not under the supervision of the practitioner.”1

    For purposes of this section, “anatomic pathology services” includes “the gross or microscopic examination and histological processing of human organ tissue; the examination of human cells from fluids, aspirates, washings, brushings, or smears; or other subcellular or molecular pathology services.”2

    The new law contains an exception for specimen collection and transportation fees if the patient is made aware of the fees in writing prior to collection and the fee conforms to the current procedural terminology codes for procedures and services of the American Medical Association.3

    Prior to enactment of the new law, a physician who ordered anatomic pathology services for his patients could include additional fees over and above the cost of the service when the pathology services were performed by an outside laboratory or pathologist. As of July 1, 2014, a physician or other healthcare provider who includes any mark-up charge to an anatomic pathology service performed by an independent pathologist could be subject to disciplinary action by the Virginia Board of Medicine.

    The bill that enacted this new statutory provision was lobbied for by the College of American Pathologists and the Virginia Society for Pathology and passed both the Virginia House and Senate unanimously. Virginia is now the twenty-fifth state in the country to prohibit mark-up billing practices on pathology services.

    Please contact the members of our Health Care Practice Group with any questions or concerns about how this new law may affect your practice. – Brac McKee, Laura Rixey

    1 VA. CODE ANN. 54.1-2962.01(A).
    2 VA. CODE ANN. 54.1-2962.01(B).
    3 VA. CODE ANN. 54.1-2962.01(B).

    The contents of this publication are intended for general information only and should not be construed as legal advice or a legal opinion on specific facts and circumstances. Copyright 2024.