Modifier 90

Does anyone know the criteria in which it would be appropriate to use the 90 modifiers on labs? I have a doctor with Lab Corp in his office. My doctor's Clia certificate only covers Clia waived tests. Therefore, any non Clia tests, my doctor is billing for and then paying Lab Corp since they are the ones performing the test. He was told this was okay if we use the 90 modifier. Please help!

medicare

It is not OK for Medicare patients. The Lab performing the tests must bill the tests.

modifier 90

[It is not OK for Medicare patients. The Lab performing the tests must bill the tests.]

Then what is the deal with the 90 modifier? thank you for responding.

Not for Medicare

You want to bill for laboratory services that you purchased from an outside lab. Use modifier -90, "Reference (Outside) Laboratory," with the appropriate laboratory-service code. Medicare requires labs to bill for such services directly, but not all insurers follow that policy

No you don't!

IMHO the -90 modifier is only for Medicare labs, you do not need to use it for commercial insurers. We never do and Blue Cross knows we do not run the labs ourselves. Hospitals use the -90 when docs order esoteric tests and the hospital has to send it to a special lab. They are allowed to bill Medicare even though they did not do the test

Modifier 90- Medicare

http://www.cms.hhs.gov/Transmittals/Downloads/R85CP.pdf

Thanks nancy

for that 24 page reference ;-) I'll read it right away

reference

it might take a week on your restroom breaks, or more!!