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Reference Lab Modifier and Medicare Secondary

penswhitex

Networker
Messages
25
Best answers
0
I'm new to Family Practice. Does anyone have any experience with billing Medicare Secondary (Cahaba in TN) for a lab code that has been sent to a reference lab? An example is 80053,90 billed to Medicare. Medicare returns as unprocessable MA130 and CO4 (procedure code is inconsistent with the modifier or a required modifier is missing). I spoke to a rep at Cahaba Medicare this morning, who told me that this particular modifier is invalid for the provider's specialty and I need a different modifier. Of course, she wouldn't tell me what that modifier was. This is a family practice physician who operates in a rural health clinic. Wasn't sure if that made a difference. Also, the reference lab is noted on the claim. I would greatly appreciate any help on this. Thanks.
 

StacyGalloway

Networker
Messages
67
Best answers
0
Not sure if this will help or not but when ever we have Medicare as an insurance on file for a patient, no matter if primary or secondary, and lab is sent "out of house" we do not bill for that particular lab test. We bill for the venipuncture and the facility that is testing the specimen bills the patients insurance. Different facilities may do this differently, but that is how our Family Practice clinic deals with "out of house" lab work.

Stacy - CFPC
 
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