Wiki Modifier 91


Harrisburg, PA
Best answers
I recently coded a pathology service with over 10 units of 88305. This was billed with all the units on 1 line. The carrier denied the entire amount stating 8 units is the limit and advised re billing with 8 units and adding modifier 91 on the next line with the remaining units. Has anyone used modifier 91 for the pathologist/professional component and what has your outcome been? Any thoughts, comments and suggestions would be appreciated!
Modifier 91 Repeat clinical diagnostic laboratory test is used to report the same lab test when performed on the same patient, on the same day, to obtain subsequent test results.

This doesn't seem to qualify, you will probably need to appeal with notes documenting that it was 10 specimen collected. Its likely a Per day edit anyways so splitting wont make a difference. Looks to be a payer custom edit as CMS MUE is 16
Last edited: