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