December 3, 2020
The current payment policy for Modifier 90-Reference (Outside) Laboratory that was to apply to facility claims as of dates of service on and after January 13, 2021 is being rescinded. The policy will not be expanded to include facility claims but will remain applicable to professional claims only.
Modifier 90 appended to a lab code (80000 series of CPT codes) billed on a professional claim indicates that the lab procedure was performed by an outside party other than the treating or reporting provider. Lab work must be submitted directly to Premera by the lab performing the actual lab test. Reimbursement will be made directly to the laboratory that performed the service(s) for those laboratory services covered by the member’s benefits.
Please review the revised payment policy for further details.