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Modifier 90 help

kparker1980

Contributor
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Hi everyone,

I was wondering if you all could help me with any information you might have regarding modifier 90. We are a laboratory and we sometimes send things to another laboratory to be tested. We are being told that we have to use modifier 90 when sending the claim, but we haven't ever used this modifier before. Basically we are wondering if we will get paid using this modifier? Has anyone else had issues with this? Any information on this would be helpful. Thank you!
 

aspantgos

New
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I also work at a laboratory and we do some reference billing as well. You do need to add the 90 modifier on each CPT that you reference out since you are not the ones performing the testing but still billing for it. As far as reimbursement it really does depend on the insurance. A lot of insurances do no pay for reference testing. Hope this helps!
 

kparker1980

Contributor
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Thank you so much for getting back to me! We are having such a hard time finding a straightforward answer on this, so i appreciate it. I was trying to find out if Medicare pays for the reference lab claims, because usually most other insurance companies follow suit with Medicare, but I haven't been able to find anything. So you have seen some of the insurance companies pay for the claims that you used the mod 90 on though?
 
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