Laboratory Question for the Week of January 22, 2018

Question:

If we perform most of the components of an obstetric panel in our hospital lab but we have to send out one component to a reference lab, would we append the modifier 90 to the entire panel, or do we have to report each component separately and append the modifier 90 to only the CPT^® code that was sent out?

Answer:

Modifier 90 does not apply to hospital claims for laboratory testing. The hospital laboratory will report the appropriate CPT code without modifier 90 appended.

The modifier is reserved for use on claims submitted by the independent laboratory that refers a specimen to another laboratory. There is no need to unbundle the CPT code for the obstetric panel for the purpose of appending the 90 modifier.

Apply the billing guidelines as applicable to the hospital laboratory setting, which would use the CMS-1450 institutional form. The physician laboratory or independent laboratory bills on the CMS-1500 professional format.

CPT^® is a registered trademark of the American Medical Association.