Reimbursement policy update: Laboratory and Venipuncture Services — Professional and Facility

In the March 2024 issue of Provider News, we announced that language was inadvertently removed from the Modifier 26 comment in Section II. The policy has been updated to include the following statement:

• When a professional provider has reported modifier 26 to procedure codes designated with NPFSRVF PC/TC indicators 3 or 9, the procedure will not be eligible for reimbursement.

Upon further review, no claims were impacted by this omission. If you believe a claim reimbursement decision should be reviewed, please follow the normal claims dispute process outlined in the provider manual.