Reimbursement policy: Modifier 90; reference (outside) laboratory and pass-through billing
Modifier 90: Reference (outside) laboratory and pass-through billing
Please note, this communication applies to Anthem HealthKeepers Plus offered by HealthKeepers, Inc.
HealthKeepers, Inc. does not allow pass-through billing for lab services. Claims appended with Modifier 90 and an office place of service will be denied unless provider, state, federal or CMS contracts and/or requirements indicate otherwise.
Reimbursement will be made directly to the laboratory that performed the clinical diagnostic laboratory test based on 100% of the applicable fee schedule or contracted/negotiated rate.
Modifier 90 is defined as when laboratory procedures are performed by a party other than the treating or reporting physician or other qualified healthcare professional. The procedure may be identified by adding Modifier 90 to the usual procedure number.
For additional information, please review the Modifier 90: Reference (outside) laboratory and pass-through billing reimbursement policy at https://mediproviders.anthem.com/va.
July 2021 Anthem Provider News - Virginia