Modifier 90

CULINTZ

Networker
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65
Location
Lakewood, OH
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Can anyone provide Place of Service (POS) information on modifier 90, Reference (Outside) Laboratory.

Is this modifier applicable only to reporting for POS 11, Office, for the treating/reporting physician or other qualified health care professional that sends a lab out for testing?

Or can a facility apply this modifier for a lab they send out for testing?

Thanks.
 

karamac

Networker
Messages
34
Location
Glendale, Arizona
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Hi Carrie,

The 90 modifier is appended any time a laboratory test is billed and a reference laboratory is used- whether being billed on a CMS-1500, or CMS-1450. Now when laboratory services are part of a bundled payment, say in the ASC setting, and not itemized on the claim form- you would then not append that modifier. Many of the commercial payers actually have guidance for facilities on where to then also append the NPI of the reference laboratory on the electronic claim format. There has been quite a bit of confusion and discussion specific to whether the 90 modifier is appropriate for facitlies, but hopefully this clear may clear up any questions you may have.
 
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