Billing Reference and Outside Lab Services

Effective for dates of service on and after January 1, 2015, in conjunction with Section 1902(a)(32) of the Social Security Act MHCP must only reimburse a provider who personally performed a service. Providers will no longer be reimbursed for lab tests they did not complete. Tests submitted with modifier 90 will be denied. Do not include lab services you did not complete on your claim. When a specimen is sent to another provider, the ordering provider must also send all necessary information required for that provider to claim for the service. For dates of services prior to January 1, 2015, providers may choose to bill for lab tests or services sent to another provider by indicating the reference lab’s NPI as the rendering provider on claim format 837P, use modifier 90 and place of service 81 (independent lab). Do not use claim format 837I to report these services. This policy applies only to lab services where the costs are paid fee-for-service. Lab services that are part of an all-inclusive inpatient hospital DRG or nursing facility rate are not affected.