June 3, 2021
In response to a
growing number of inquiries on the correct billing of laboratory and pathology
services, a new payment policy will be effective with claim process dates on
and after July 5, 2021.
The policy includes (but not limited to) the following:
- Lab panel
services (CPT lab panel codes and proprietary lab panels):
Lab panel services, whether billed using an existing CPT lab panel code or for proprietary
lab panels that are a unique make-up of a variety of individual lab tests
that are not defined by a CPT code (e.g., cardiovascular panels, genetic
panels, etc.) must all be billed on the same date of service and on the
same claim form in order to be reimbursed.
- Surgical
Pathology services (88300-88309):
The unit of service for these codes is the specimen, the tissue(s) submitted
for examination. When two or more specimens are submitted utilizing the same
CPT procedure code, the second and subsequent specimens need to be
distinguished by a modifier (ex. XS, XU or 91) to indicate a separate and
distinct specimen.
- Professional
and Technical components:
These components are identified based on the current CMS National Physician Fee
Schedule "PC/TC" indicator flags. The appending of modifier 26 or TC
(professional and technical components respectively) will be based on this
indicator flag.
To read the full policy and additional billing guidelines, sign in to your One Health Port account.