Wiki Physcian owned Laboratory

[inc1961]

We a pain management facility with a physician owned lab (POL), Not an "independent lab". We have always billed with POS 11 (office). Samples are obtained during a face to face in the office and run off site at the POL.

With the new CPT codes for urine drug screenings we are running in consistent denials, especially from Horizon BCBS and blue card submissions.

Our denial is "The procedure code is inconsistent with the place of service".

We are being told these tests are only reimbursable if run in an independent lab facility, (POS 81) which we do not meet the criteria for.

Any advice on how to have our claims favorably processed?

Thank you

 

[cgifford]

I would contact your BCBS provider rep and see if they can help with the issue.

 

[inc1961]

Thank you. I would contact a BCBS rep in other instances, however this provider is not participating and thus has no representative.

I did manage to find a eligibility representative yesterday, who said there was no policy on POS billing with lab tests and would have 'a' claim reprocessed. We will go from there.

Thanks again, and I appreciate any insight!!