All in-network Preferred Medical Doctors (PMD) and advanced practice providers (APP) can be reimbursed for the laboratory services listed in Exhibit I of the PMD Agreement. Providers who perform laboratory services beyond Exhibit I are encouraged to get designated as a PPL. 

Note: Having the PPL designation opens availability of reimbursement to all lab CPT codes. There are no further limitations of codes; however, other limitations such as medical policy and frequency still apply.

Requirements to Become a PPL

To be a PPL, the physical location must have a Clinical Laboratory Improvement Amendments of 1988 (CLIA) higher than the CLIA-waived level certificate, which is managed by the Alabama Department of Public Health (ADPH). Contact ADPH for more information on obtaining a CLIA. 

Enrolling as a PPL

To enroll each provider from your CLIA-designated location as a PPL, complete the PPL Application on ProviderAccess. Once approved, providers at that specific location are considered a PPL. 

To verify each provider’s status in a PPL, log in to ProviderAccess and select “Preferred Physician Laboratory” under Profiles & Reports. 

Note: It is the practice’s responsibility to remember that every time they add a new provider, they must also complete the PPL Application to get that new provider classified as a PPL.

Practices with Multiple Locations 

CLIAs are location specific, so a provider might have one location identified as a PPL and other locations without it. Should a provider’s CLIA status end, their PPL designation should end as well. Should a provider move locations, they would have to go through the process of obtaining a CLIA at their new site, which is managed by ADPH.

If a practice has multiple locations, and only one location has the appropriate CLIA certification and is set up as a PPL, providers at other locations might still send lab work to that certified site—even if they don’t work there themselves. In this case, the practice should apply for a provider number for those referring providers at the PPL location, so their lab claims can be billed correctly.

Note: Providers should only bill for the services they provide and should not engage in pass-through billing.