Billing for tests done at reference labs

klmundy

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I know that there is modifier -90 to use to indicate a lab test was not performed on-site, but rather by an off-site reference lab. My question is: Is there a restriction as to whether or not a facility can or cannot bill for these tests? Is it based on size or staffing of the facility? Or can any facility that sends lab tests out to be performed bill the patient or the insurer for the cost of the tests. Of course, that is to assume that the reference lab itself is not filing claims as well.
 

tomtom2

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The Medicare Claims Processing Manual Chapter 16 - Laboratory Services 40.1 will answer you question.
 

S Avara CPC

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In my experience this has been based on the insurance carriers specifications. For instance, you should not bill labs performed by an outside lab to Medicare or Medicaid but most other carriers will reimburse labs with a modifier 90. You may want to call your local carriers and see what their policy is on this. Hope this helps!
 
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