Erroneously Denied Claims for Lab Codes (80000-89999) Using Modifier 90

Updated on July 30, 2021

Effective for claims adjudicated on or after December 28, 2020, lab service CPT^® codes 80000 to 89999 in conjunction with Modifier 90 were erroneously denied.

Provider billing guidance for select lab services for Outpatient Hospitals, Provider Type 15 were published prior to the implementation of the system changes necessary to support appropriate adjudication. Providers who submitted claims for these services were denied erroneously with Remittance Advice Details (RAD) code 111 (This provider type is ineligible for the modifier billed). An Erroneous Payment correction (EPC) is being installed to reprocess any impacted claims.

Providers may also elect to use this updated billing policy to correct and resubmit previously denied claims as described in the CIF Submission and Timeliness Instructions section of the Provider Manual.

Source: https://files.medi-cal.ca.gov/pubsdoco/newsroom/newsroom_30786_06.aspx