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Thread: Modifier -90 and Medicare

  1. #1

    Default Modifier -90 and Medicare

    AAPC: Back to School
    I'm pretty new to billing and just recently became a Certified Coder. Medicare is still a learning curve for me. Can you bill Medicare for labs that were drawn in your facility but, sent to an outside lab using modifier -90? Any help is greatly appreciated!

  2. #2
    Join Date
    Apr 2007


    In our offices we only bill the venipuncture as it is done in the facility, and the labs are coded at the hospital for Medicare. Medicare, as it was explained to me, does not accept modifier 90 for labwork. If in doubt I often go to the CMS.gov website and search there, they have a lot of information, it's just wading through it can be time consuming. Hope that helps.

  3. #3
    Join Date
    Apr 2007
    North Carolina


    Independent laboratories shall use modifier 90 to identify all referred laboratory services. A claim for a referred laboratory service that does not contain the modifier 90 is returned as unprocessable if the claim can otherwise be identified as being for a referred service.

    Section 40.1.1


  4. #4


    Thank you for your help!

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