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Provider Manual

Physician Billing for the Lab Service

Last Updated on October 15, 2018
  • The provider should bill the appropriate lab CPT code (8XXXX) with modifier 90 to indicate it was sent out.
  • Enter the name of the outside lab in box 19 on the CMS 1500 claim form.
  • Bill the specimen handling (CPT 99000 or 99001) and venipuncture (CPT 36415) when appropriate.
    • Only one handling fee (CPT 99000 or 99001) will be reimbursed per member, per provider sending out, per lab, per date of service, regardless of the number of specimens sent to a specific lab.
      • Exception: If different handling or shipping types are needed to send more than one specimen to the same lab. More than one handling fee may be considered if supporting documentation is provided for review. In this instance bill each handling fee as a separate line item on the claim; do not quantity bill.
  •  Labs billed with 90 modifier for Commercial members will be reimbursed per the Security Health Plan Outreach Lab Fee Schedule.

Reference Lab Billing for the Lab Service

  • The lab should bill the appropriate lab CPT code (8XXXX).
  • In box 24b on the CMS 1500 claim form, enter place of service 81.
  • The physician may bill for specimen handling (CPT 99000 or CPT 99001) or venipuncture (CPT 36415) when appropriate.
  • Only one handling fee (CPT 99000 or CPT 99001) will be reimbursed per member, per provider sending out, per lab, per date of service, regardless of the number of specimens sent to a specific lab.
    • Exception: If different handling or shipping types are needed to send more than one specimen to the same lab. More than one handling fee may be considered if supporting documentation is provided for review. In this instance bill each handling fee as a separate line item on the claim; do not quantity bill.
  • Labs billed with place of service 81 for Commercial members will be reimbursed per the Security Health Plan Reference Lab fee schedule.