Laboratory Services Policy...that you are reimbursed based on the code or codes that correctly describe the health care services provided. UnitedHealthcare Community Plan reimbursement

REIMBURSEMENT POLICY

CMS-1500

Proprietary information of UnitedHealthcare Community Plan. Copyright 2014 United HealthCare Services, Inc. 2014R0014F

Laboratory Services Policy

Policy Number

2014R0014F Annual Approval Date

1/27/2014 Approved By

National Reimbursement Forum

United HealthCare Community & State Payment Policy Committee

IMPORTANT NOTE ABOUT THIS REIMBURSEMENT POLICY

You are responsible for submission of accurate claims. This reimbursement policy is intended to ensure that you are reimbursed based on the code or codes that correctly describe the health care services provided. UnitedHealthcare Community Plan reimbursement policies uses Current Procedural Terminology (CPT

®*), Centers for Medicare and Medicaid Services (CMS) or other coding guidelines.

References to CPT or other sources are for definitional purposes only and do not imply any right to reimbursement. This reimbursement policy applies to all health care services billed on CMS 1500 forms and, when specified, to those billed on UB04 forms. Coding methodology, industry-standard reimbursement logic, regulatory requirements, benefits design and other factors are considered in developing reimbursement policy. This information is intended to serve only as a general reference resource regarding UnitedHealthcare Community Plan’s reimbursement policy for the services described and is not intended to address every aspect of a reimbursement situation. Accordingly, UnitedHealthcare Community Plan may use reasonable discretion in interpreting and applying this policy to health care services provided in a particular case. Further, the policy does not address all issues related to reimbursement for health care services provided to UnitedHealthcare Community Plan enrollees. Other factors affecting reimbursement supplement, modify or, in some cases, supersede this policy. These factors include, but are not limited to: federal &/or state regulatory requirements, the

physician or other provider contracts, the enrollee’s benefit coverage documents, and/or other

reimbursement, medical or drug policies. Finally, this policy may not be implemented exactly the same way on the different electronic claims processing systems used by UnitedHealthcare Community Plan due to programming or other constraints; however, UnitedHealthcare Community Plan strives to minimize these variations. UnitedHealthcare Community Plan may modify this reimbursement policy at any time by publishing a new version of the policy on this Website. However, the information presented in this policy is accurate and current as of the date of publication. UnitedHealthcare Community Plan uses a customized version of the Optum Claims Editing System known as iCES Clearinghouse to process claims in accordance with UnitedHealthcare Community Plan reimbursement policies..

*CPT® is a registered trademark of the American Medical Association

Proprietary information of UnitedHealthcare Community and State

Copyright 2014 United HealthCare Services, Inc.

Application

This reimbursement policy applies to UnitedHealthcare Community Plan Medicaid and Medicare products. This reimbursement policy applies to services reported using the 1500 Health Insurance Claim Form (a/k/a CMS-1500) or its electronic equivalent or its successor form. This policy applies to all products and all network and non-network physicians and other qualified health care professionals, including, but not limited to, non-network authorized and percent of charge contract physicians and other qualified health care professionals.

Payment Policies for Mississippi CHIP, Medicare & Retirement and Employer & Individual please use this link.

https://www.unitedhealthcareonline.com/b2c/CmaAction.do?channelId=ca174ccb4726b010VgnVCM100000c520720a____


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Medicare & Retirement Policies are listed under Medicare Advantage Reimbursement Policies. Mississippi CHIP and Employer & Individual are listed under Reimbursement Policies-Commercial.

Table of Contents

Policy Overview Reimbursement Guidelines Place of Service Date of Service Duplicate Laboratory Charges Laboratory Services Performed in a Facility Setting Modifiers Laboratory Panels Organ or Disease-Oriented Laboratory Panel Codes Basic Metabolic Panel (Calcium, Ionized) 80047 Basic metabolic Panel (Calcium, Total) 80048 General Health Panel, 80050 Electrolyte Panel, 80051 Comprehensive Metabolic Panel, 80053 Obstetric Panel, 80055 Lipid Panel, 80061 Renal Function Panel, 80069 Acute Hepatitis Panel, 80074 Hepatic Function Panel, 80076 Surgical Pathology Venipuncture Laboratory Handling Clinical and Surgical Pathology Consultations (80500-80502 & 88321-88325) Qualitative Laboratory Services (80100, 80103, 80104) Definitions Questions and Answers Attachments Resources History

Policy

Overview

This policy describes the reimbursement methodology for laboratory panels and individual Component Codes, as well as reimbursement for venipuncture services, laboratory services performed in a facility setting, laboratory handling, surgical pathology and clinical pathology consultations. The policy also addresses place of service and date of service relating to laboratory services.

Duplicate laboratory code submissions by the same or multiple physicians or other health care professionals, as well as certain laboratory services provided in a facility place of service, are also addressed in this policy.

Note this policy does not address reimbursement for all laboratory codes. Coding relationships for laboratory topics not included within this policy are administered through the UnitedHealthcare Community Plan “Rebundling” and “CCI Editing” policies.


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Reimbursement Guidelines

Place of Service

UnitedHealthcare Community Plan uses the codes indicated in the Centers for Medicare and Medicaid Services (CMS) Place of Service (POS) Codes for Professional Claims Database to determine if laboratory services are reimbursable.

CMS Place of Service Database

The POS designation identifies the location where the laboratory service was provided, except in the case of a Reference Laboratory. A Reference Laboratory must show the place where the sample was taken (if drawn in the Reference Lab, POS 81 is shown; if drawn in a hospital inpatient setting, the appropriate inpatient POS is shown). All entities billing for laboratory services should append identifying modifiers (e.g., 90), when appropriate, in accordance with correct coding. For example, a physician billing for a laboratory service provided by a Reference Laboratory would bill with POS 81 and would append modifier 90 to the code.

For additional information, refer to the Questions and Answers section, Q&A #1.

Date of Service

The date of service (DOS) on a claim for a laboratory test is the date the Specimen was collected and if collected over 2 calendar days, the DOS is the date the collection ended.

Refer to the UnitedHealthcare Community Plan "Professional/Technical Component Policy" for guidelines on reporting the date of service for laboratory tissue Specimens collected during a surgical procedure, stored Specimens and chemotherapy sensitivity testing on live tissue samples.

Duplicate Laboratory Charges

Same Group Physician or Other Health Care Professional Only one laboratory service is reimbursable when Duplicate Laboratory Services are submitted from the Same Group Physician or Other Health Care Professional. CPT codes 82947 and 82948 are excluded from Duplicate Laboratory Services.

Separate consideration will be given to repeat procedures (i.e., two laboratory procedures performed the same day) by the Same Group Physician or Other Health Care Professional when reported with modifier 91. Modifier 91 is appropriate when the repeat laboratory service is performed by a different individual in the same group with the same Federal Tax Identification number.

According to CMS and CPT guidelines, Modifier 91 is appropriate when, during the course of treatment, it is necessary to repeat the same laboratory test for the same patient on the same day to obtain subsequent test results, such as when repeated blood tests are required at different intervals during the same day.

Consistent with the American Medical Association’s (AMA) coding guidelines, modifier 59 may be used when the same laboratory services are performed for the same patient on the same day. UnitedHealthcare Community Plan will reimburse laboratory services reported with modifier 59 for different species or strains, as well as Specimens from distinctly separate anatomic sites

For additional information, refer to the Questions and Answers section, Q&A #2, and #4.

According to the AMA and CMS, it is inappropriate to use modifier 76 or 77 to indicate repeat laboratory services. Modifiers 59 or 91 should be used to indicate repeat or distinct laboratory services when reported by the Same Group Physician or Other Health Care Professional. Separate consideration for reimbursement will not be given to laboratory codes reported with modifier 76 or 77.

http://www.cms.gov/Medicare/Coding/place-of-service-codes/Place_of_Service_Code_Set.html


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Multiple Physicians or Other Health Care Professionals Only one laboratory provider will be reimbursed when multiple individuals report Duplicate Laboratory Services. Multiple individuals may include, but are not limited to, any physician or other health care professional, Reference Laboratory, Referring Laboratory or pathologist reporting duplicate services. CPT codes 82947 and 82948 are excluded from Duplicate Laboratory Services.

For additional information, refer to the Questions and Answers section, Q&A #3.

Reference Laboratory and Non-Reference Laboratory Providers: When laboratory procedures are reported by a Non-Reference Laboratory Provider and performed by Reference Laboratory, the procedure(s) should be reported with modifier 90 to identify that the services were performed by a Reference Laboratory. UnitedHealthcare Community Plan's participation agreements generally prohibit reimbursement of laboratory services that are performed by a party other than the treating or reporting physician. If a Reference Laboratory and a Non-Reference Laboratory Provider submit Duplicate Laboratory Services only the Reference Laboratory service is reimbursable unless the Non-Reference Laboratory Provider appends a modifier 91 to the code(s) submitted.

Reference Laboratory and Referring Laboratory: Laboratory services billed with modifier 90 by a Referring Laboratory are reimbursable if a duplicate claim has not been received from a Reference Laboratory. Duplicate services are not reimbursable, unless one laboratory appends modifier 91 to the code(s) submitted.

Pathologist and Physician Office Laboratory Providers: If a pathologist and Physician Office Laboratory provider submit Duplicate Laboratory Services, only the pathologist's service is reimbursable, unless the Physician Office Laboratory provider appends a modifier 91 to the codes submitted.

For additional information, refer to the Questions and Answers section, Q&A #5

Anatomic Pathology Services and Purchased Diagnostic Services: UnitedHealthcare Community Plan reimburses Purchased Diagnostic Tests that are subject to the professional/technical concept submitted with modifier 90 by a physician or pathologist. If both the purchaser and supplier who performed the service bill Duplicate Laboratory Services, only one service is reimbursable, unless modifier 59 or 91 is appended. Purchased Diagnostic Tests do not apply to automated or manual laboratory tests. UnitedHealthcare Community Plan uses the Centers for Medicare and Medicaid Services (CMS) National Physician Fee Schedule (NPFS) Professional Component/Technical Component (PC/TC) indicators 1, 6, and 8 to identify laboratory services that are eligible as Purchased Diagnostic Tests. PC/TC Indicator 1: Physician Service Codes (modifier TC and 26 codes) PC/TC Indicator 6: Laboratory Physician Interpretation Codes PC/TC Indicator 8: Physician Interpretation Codes

2014A UnitedHealthcare Community Plan Purchased Laboratory Eligible Codes

For more complete information regarding when a professional or technical component is billed, refer to the UnitedHealthcare Community Plan "Professional/Technical Component" policy. Refer to the UnitedHealthcare Community Plan “Maximum Frequency per Day policy for additional information on assigned MFD values.


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Laboratory Services Performed in a Facility Setting

The established policy for reimbursement of laboratory services performed in a facility setting is consistent with UnitedHealthcare Community Plan's policy not to pay for duplicative laboratory services.

Manual and automated laboratory services submitted by a reference or Non-Reference Laboratory Provider with a CMS facility POS 21, 22, 23, 26, 34, 51, 52, 56 or 61 will not be reimbursable. These services are reimbursable to the facility. When facilities obtain manual or automated laboratory tests for patients under arrangements with a Reference Laboratory or pathology group, only the facility may be reimbursed for the services.

Note: UnitedHealthcare Community Plan will make an exception to this policy for reproductive laboratory medicine procedures 89250-89398 when the facility laboratory is not equipped to perform these specialized services and refers them to a reproductive laboratory. In the event that both a facility and a Reference Laboratory report the same service on the same day for the same member, only the facility reproductive laboratory services may be reimbursed.

UnitedHealthcare Community Plan uses the CMS National Physician Fee Schedule (NPFS) Professional Component/Technical Component (PC/TC) indicators 3 and 9 to identify laboratory services that are not reimbursable to a reference or non-reference provider in a facility setting.

PC/TC indicator 3: Technical Component Only Codes PC/TC indicator 9: PC/TC Concept Not Applicable

2014A UnitedHealthcare Community Plan Laboratory Codes with a PC/TC Status Indicator of 3 or 9

For more complete information on when a professional or technical component is billed refer to the UnitedHealthcare Community Plan "Professional/Technical Component Policy."

Modifiers

Modifier Description

Modifier 59

-Distinct Procedural Service Under certain circumstances, it may be necessary to indicate that a procedure or service was distinct or independent from other non-E/M services performed on the same day. Modifier 59 is used to identify procedures/services, other than E/M services, that are not normally reported together, but are appropriate under the circumstances. Documentation must support a different session, different procedure or surgery, different site or organ system, separate incision/excision, separate lesion, or separate injury (or area of injury in extensive injuries) not ordinarily encountered or performed on the same day by the same individual. However, when another already established modifier is appropriate it should be used rather than modifier 59. Only if no more descriptive modifier is available, and the use of modifier 59 best explains the circumstances, should modifier 59 be used.

Modifier 90

-Reference (Outside) Laboratory When laboratory procedures are performed by a party other than the treating or reporting physician, or other qualified health care professional, the procedure may be identified by adding the modifier 90 to the usual procedure number.

Modifier 91

-Repeat Clinical Diagnostic Laboratory Test In the course of treatment of the patient, it may be necessary to repeat the same laboratory test on the same day to obtain subsequent (multiple) test results. Under these circumstances, the laboratory test performed can be identified by its usual procedure number and the addition of modifier 91. Note: This modifier may not be used when tests are rerun to confirm initial results; due to testing problems with specimens or equipment; or for any other reason when a normal, one-time, reportable result is all that is required. This modifier may not be used when other code(s) describe a series of test results (eg,


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glucose tolerance tests, evocative/suppression testing). This modifier may only be used for laboratory test(s) performed more than once on the same day on the same patient.

Modifier 92

-Alternative Laboratory Platform Testing When laboratory testing is being performed using a kit or transportable instrument that wholly or in part consists of a single use, disposable analytical chamber, the service may be identified by adding modifier 92 to the usual laboratory procedure code (HIV testing 86701-86703, and 87389). The test does not require permanent dedicated space; hence by its design it may be hand carried or transported to the vicinity of the patient for immediate testing at that site, although location of the testing is not in itself determinative of the use of this modifier.

Laboratory Panels

Individual laboratory codes, which together make up a laboratory Panel Code, will be combined into and reimbursed as the more comprehensive laboratory Panel Code as described under the specific laboratory panel headings below.

Organ or Disease-Oriented Laboratory Panel Codes

**This section on Laboratory Panel Codes does not apply to any Medicare lines of business**

The Organ or Disease-Oriented Panels as defined in the CPT book are codes 80047, 80048, 80050, 80051, 80053, 80055, 80061, 80069, 80074, and 80076. According to the CPT book, these panels were developed for coding purposes only and are not to be interpreted as clinical parameters. UnitedHealthcare Community Plan uses CPT coding guidelines to define the components of each panel.

UnitedHealthcare Community Plan also considers an individual component code included in the more comprehensive Panel Code when reported on the same date of service by the Same Individual Physician or Other Health Care Professional. The Professional Edition of the CPT ® book, Organ or Disease-Oriented Panel section states: "Do not report two or more panel codes that include any of the same constituent tests performed from the same patient collection. If a group of tests overlaps two or more panels, report the panel that incorporates the greater number of tests to fulfill the code definition and report the remaining tests using individual test codes."

For reimbursement purposes, UnitedHealthcare Community Plan differs from the CPT book's inclusion of the specific number of Component Codes within an Organ or Disease-Oriented Panel. UnitedHealthcare Community Plan will bundle the individual Component Codes into the more comprehensive Panel Code when the combined reimbursement for the individual Panel Code(s) exceeds the reimbursement amount of the Panel Code or when the designated number of Component Codes identified within a Panel Code are submitted as set forth more fully in the tables below. The tables for CPT codes 80047, 80048, 80050, 80051, 80053, 80061, 80069, 80074 and 80076 identify the Component Codes that UnitedHealthcare Community Plan will rebundle into the specific panel.

Basic Metabolic Panel (Calcium, ionized), 80047

CPT coding guidelines indicate that a Basic Metabolic Panel (Calcium, ionized), CPT code 80047 should not be reported in conjunction with CPT code 80053. If a submission includes CPT 80047 and CPT 80053, only CPT 80053 will be reimbursed.

There are 2 configurations for a Basic Metabolic Panel, CPT code 80047:

1. A submission that includes CPT code 82330 plus 4 or more of the following laboratory Component Codes by the Same Individual Physician or Other Health Care Professional for the same patient on the same date of service is a reimbursable service as a Basic Metabolic Panel (Calcium, ionized), CPT code 80047.


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Panel Code

Component Code

Code Description

80047 Basic Metabolic Panel (Calcium, ionized), 80047

Includes the following:

82330 Calcium; ionized

Plus 4 or more of the following Component Codes for the same patient on the same date of service:

82374 Carbon Dioxide (bicarbonate)

82435 Chloride; blood

82565 Creatinine; blood

82947 Glucose; quantitative, blood (except reagent strip)

84132 Potassium; serum, plasma or whole blood

84295 Sodium; serum, plasma or whole blood

84520 Urea nitrogen (BUN)

2. A submission that includes an Electrolyte Panel, CPT code 80051 plus 1 or more of the following laboratory Component Codes by the Same Individual Physician or Other Health Care Professional for the same patient on the same date of service is a reimbursable service as a Basic Metabolic Panel (Calcium, ionized) CPT code 80047.

Panel Code

Component Code

Code Description

80047 Basic Metabolic Panel (Calcium, ionized), 80047

Includes the following panel:

80051 Electrolyte Panel

Plus the following component code:

82330 Calcium; ionized

Plus at least one of the following Component Codes for the same patient on the same date of service:




Basic Metabolic Panel (Calcium, total), 80048

CPT coding guidelines indicate that a Basic Metabolic Panel (Calcium, total), CPT code 80048 should not be reported in conjunction with 80053. If a submission includes CPT 80048 and CPT 80053, only CPT 80053 will be reimbursed. There are 2 configurations for a Basic Metabolic Panel (Calcium, total), CPT code 80048:

1. A submission that includes 5 or more of the following laboratory Component Codes by the Same Individual Physician or Other Health Care Professional for the same patient on the same date of service is a reimbursable service as a Basic Metabolic Panel (Calcium, total), CPT code 80048.

Panel Code

Component Code

Code Description

80048 Basic Metabolic Panel (Calcium, total), 80048


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Must contain 5 or more of the following Component Codes for the same patient on the same date of service

82310 Calcium; total








2. A submission that includes an Electrolyte Panel, CPT code 80051 plus 1 or more of the following laboratory Component Codes by the Same Individual Physician or Other Health Care Professional for the same patient on the same date of service is a reimbursable service as a Basic Metabolic Panel (Calcium, total) CPT code 80048.

Panel Code

Component Code

Code Description

80048 Basic Metabolic Panel (Calcium, total), 80048



. Plus 1 or more of the following Cmponent Codes for the same patient on the same date of service:





General Health Panel, 80050

A submission that includes a Comprehensive Metabolic Panel, CPT code 80053, a Thyroid Stimulating Hormone, CPT code 84443 and one of the following CBC or combination of CBC Component Codes, either CPT codes 85025 or 85027 + 85004 or 85027 + 85007 or 85025 + 85009 by the Same Individual Physician or Other Health Care Professional for the same patient on the same date of service is a reimbursable service as a General Health Panel, CPT code 80050.

Panel Code

Component Code

Code Description

80050 General Health Panel


80053 Comprehensive Metabolic Panel


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Includes the following component code:

84443 Thyroid Stimulating Hormone (TSH)

Plus one of the following CBC or combination of CBC Component Codes for the same patient on the same date of service:

85025 Blood Count; complete (CBC) automated (Hgb, Hct, RBC, WBC and platelet count) and automated differential WBC count

85027 + 85004

Blood Count; complete (CBC) automated (Hgb, Hct, RBC, WBC and platelet count) AND Blood count; automated differential WBC count

85027 + 85007

Blood Count; complete (CBC) automated (Hgb, Hct, RBC, WBC and platelet count) AND Blood count; blood smear, microscopic examination with manual differential WBC count

85027 + 85009

Blood Count; complete (CBC) automated (Hgb, Hct, RBC, WBC and platelet count) AND Blood count; manual differential WBC count, buffy coat

When Hepatic Function Panel code 80076 is submitted on the same date of service by the Same Individual Physician or Other Health Care Professional for the same patient as General Health Panel code 80050, CPT code 80076 will not be separately reimbursed.

Comprehensive Metabolic Panel code 80053, a component of Panel Code 80050, includes all components of Hepatic Function Code 80076 except for code 82248 (bilirubin, direct).

Electrolyte Panel, 80051

A submission that includes 2 or more of the following laboratory Component Codes by the Same Individual Physician or Other Health Care Professional for the same patient on the same date of service is a reimbursable service as an Electrolyte Panel, CPT code 80051.

Panel Code

Component Code

Code Description


Includes two or more of the following individual Component Codes for the same patient on the same date of service:





Comprehensive Metabolic Panel, 80053

There are 3 configurations for a Comprehensive Metabolic Panel, CPT code 80053:


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1. A submission that includes 10 or more of the following laboratory Component Codes by the Same Individual Physician or Other Health Care Professional for the same patient on the same date of service is a reimbursable service as a Comprehensive Metabolic Panel, CPT code 80053.

Panel Code

Component Code

Code Description


Must contain 10 or more of the following Component Codes for the same patient on the same date of service:

82040 Albumin; serum, plasma or whole blood

82247 Bilirubin; total


82374 Carbon dioxide (bicarbonate)



82947 Glucose quantitative, blood (except reagent strip)

84075 Phosphatase, alkaline


84155 Protein, total, except by refractometry; serum, plasma or whole blood


84450 Transferase, aspartate amino (AST) (SGOT)

84460 Transferase, alanine amino (ALT) (SGPT)

84520 Urea Nitrogen (BUN)

2. A submission that includes a Basic Metabolic Panel (Calcium, total), CPT code 80048, and 2 or more of the following laboratory Component Codes by the Same Individual Physician or Other Health Care Professional for the same patient on the same date of service is a reimbursable service as a Comprehensive Metabolic Panel, CPT code 80053.

Panel Code

Component Code

Code Description



80048 Basic Metabolic Panel (Calcium, total)





84155 Protein, total


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84460 Transferase; alanine amino (ALT) (SGPT)

3. A submission that includes an Electrolyte Panel, CPT code 80051, and 6 or more of the following laboratory Component Codes by the Same Individual Physician or Other Health Care Professional for the same patient on the same date of service is a reimbursable service as a Comprehensive Metabolic Panel, CPT code 80053.

Panel Code

Component Code

Code Description













84460 Transferase; alanine amino (ALT) (SGPT)


When the Same Individual Physician or Other Health Care Professional reports CPT 80053 with CPT 80048 or CPT 80076 for the same patient on the same date of service, neither CPT 80048 nor CPT 80076 will be reimbursed separately.

CPT Panel Code 80053 includes all of the components of CPT Panel Code 80048 and all the components of CPT Panel Code 80076, except for CPT 82248 (bilirubin, direct). Therefore, when performed with all of the components of CPT 80053, report CPT 82248 separately.

Obstetric Panel, 80055

A submission that includes one of the following CBC or combination of CBC Component Codes, either CPT codes 85025 or 85027 + 85004 or CPT codes 85027 + 85007 or 85027 + 85009 and each component CPT code Syphilis, non-treponemal antibody 86592, Antibody, Rubella, 86762, RBC antibody screen, 86850, Blood typing ABO, 86900, Blood typing RH (D), 86901 and Hepatitis B surface antigen (HBsAg), 87340 by the Same Individual Physician or Other Health Care Professional for the same patient on the same date of service is a reimbursable service as an Obstetric Panel, CPT code 80055.

NOTE: The Hepatitis B Surface Antigen (87340) is a component code of both the Obstetric Panel (80055) and the Acute Hepatitis Panel (80074). The Obstetric Panel takes Precedence.


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Panel Code

Component Code

Code Description

80055 Obstetric Panel

Includes one of the following CBC or combination of CBC Component Codes for the same patient on the same date of service:

85025 Blood Count; complete (CBC) automated (Hgb, Hct, RBC, WBC and platelet count) and automated differential WBC count

85027 + 85004

Blood count; complete (CBC) automated (Hgb, Hct, RBC, WBC and platelet count) Hemogram and platelet count, automated complete differential WBC count (CBC) AND Blood count; automated differential WBC count

85027 + 85007

Blood count; complete (CBC) automated (Hgb, Hct, RBC, WBC and platelet count) Hemogram and platelet count, automated complete differential WBC count (CBC) AND Blood count; blood smear, microscopic examination with manual differential WBC count

85027 + 85009

Blood count; complete (CBC) automated (Hgb, Hct, RBC, WBC and platelet count) Hemogram and platelet count, automated complete differential WBC count (CBC) AND Blood count; manual differential WBC count, buffy coat

Plus each of the following Component Codes for the same patient on the same date of service:

86592 Syphilis test, non-treponemal antibody; qualitative (e.g., VDRL, RPR, ART)

86762 Antibody; Rubella

86850 RBC, antibody screen

86900 Blood typing; ABO

86901 Blood typing; Rh (D)

87340 Hepatitis B surface antigen (HBsAg)

Lipid Panel, 80061

A submission that includes all of the following laboratory Component Codes by the Same Individual Physician or Other Health Care Professional for the same patient on the same date of service is a reimbursable service as a Lipid Panel, CPT code 80061.

Panel Code

Component Code

Code Description

80061 Lipid Panel

Includes all of the following Component Codes for the same patient on the same date of service:

82465 Cholesterol, serum or whole blood; total

83718 Lipoprotein direct measurement high density cholesterol (HDL cholesterol)


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84478 Triglycerides

Renal Function Panel, 80069

A submission that includes 6 or more of the following laboratory Component Codes by the same individual physician or health care professional for the same patient on the same date of service is a reimbursable service as a Renal Function Panel, CPT code 80069.

NOTE: Renal Function Panel, 80069, includes the Basic Metabolic Panel, CPT code 80048, submitted by the Same Individual Physician or Other Health Care Professional for the same patient on the same date of service.

Panel Code

Component Code

Code Description

80069 Renal Function Panel

Includes 6 or more of the following Component Codes for the same patient on the same date of service:



82374 Carbon dioxide (bicarbonate)




84100 Phosphorus inorganic (phosphate)




Acute Hepatitis Panel, 80074

A submission that includes all of the following laboratory Component Codes by the Same Individual Physician or Other Health Care Professional for the same patient on the same date of service is a reimbursable service as an Acute Hepatitis Panel, CPT code 80074.

NOTE: Hepatitis B Surface Antigen (87340) is a Component Code for both the Obstetric Panel, CPT code 80055, and the Acute Hepatitis Panel, CPT code 80074. The Obstetric Panel, CPT code 80055, takes Precedence.

Panel Code

Component Code

Code Description

80074 Acute Hepatitis Panel

Includes all of the following Component Codes for the same patient on the same date of service:

86705 Hepatitis B core antibody IgM (HBcAb)

86709 Hepatitis A antibody (HAAb), IgM

86803 Hepatitis C antibody

87340 Hepatitis B surface antigen (HBsAg)


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Hepatic Function Panel, 80076

A submission that includes 4 or more of the following laboratory Component Codes by the Same Individual Physician or Other Health Care Professional for the same patient on the same date of service is a reimbursable service as a Hepatic Function Panel, CPT code 80076.

Panel Code

Component Code

Code Description

80076 Hepatic Function Panel

Includes 4 or more of the following Component Codes for the same patient on the same date of service:


82247 Bilirubin, total

82248 Bilirubin, direct




84460 Transferase, alanine amino (ALT) ( SGPT)

Surgical Pathology

Surgical Pathology CPT codes 88300-88309 describe gross and microscopic examination and pathologic diagnosis of Specimen(s) submitted. Two or more Specimens separately identified from the same patient are each assigned an individual code reflective of its proper level of service. Under certain circumstances, the physician may need to report the same surgical pathology code for multiple Specimens for the same patient on the same date of service.

Pathology Specimens from the same anatomic site reported with the same Surgical Pathology CPT code may be reported on one line with multiple units.

Duplicate pathology Specimens reported with the same Surgical Pathology CPT code must be reported with a modifier 59 or 91 to receive separate consideration.

Venipuncture

Consistent with CMS, only one collection fee for each type of Specimen per patient encounter, regardless of the number of Specimens drawn, will be allowed. A collection fee will not be reimbursed to anyone who did not extract the Specimen.

Venous blood collection by venipuncture and capillary blood Specimen collection (CPT codes 36415 and 36416) will be reimbursed once per physician or other health care professional per patient per date of service. When CPT code 36416 is submitted with CPT code 36415, CPT code 36415 is the only venipuncture code considered eligible for reimbursement. No modifier overrides will exempt CPT code 36416 from bundling into CPT code 36415.

Collection of a Specimen from a completely implantable venous access device and from an established catheter (CPT codes 36591 and 36592) will not be considered separately reimbursable when submitted with any other service. UnitedHealthcare Community Plan considers CPT codes 36591 and 36592 bundled into the other services for which payment is made. When CPT code 36591 is submitted with CPT code 36592, CPT code 36592 is the only venipuncture code considered eligible for reimbursement. No modifier overrides will exempt CPT code 36591 from bundling into CPT code 36592.


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UnitedHealthcare Community Plan considers venipuncture code S9529 (Routine venipuncture for collection of Specimen(s), single homebound, nursing home, or skilled nursing facility patient) a non-reimbursable service. The description for S9529 focuses on place of service for a service that is more precisely represented by CPT code 36415 and reported with the appropriate CMS place of service code. UnitedHealthcare Community Plan considers CPT code 36416 an integral part of an E&M service when performed on the same date of service by the same provider. When CPT code 36416 is submitted with an E&M service, only the E&M service will be considered for reimbursement. No modifier overrides will exempt CPT code 36416 from bundling into an E&M service.

Laboratory Handling

Laboratory handling and conveyance CPT codes 99000 and 99001 and HCPCS code H0048 are included in the overall management of a patient and are not separately reimbursed when submitted with another code, or when submitted as the only code on a claim for the same date of service.

Clinical and Surgical Pathology Consultations (80500 – 80502 and 88321 – 88325)

CPT codes 80500, 80502, and 88321 – 88325 are reimbursable services only to Reference Laboratories and to providers whose primary specialty is pathology or dermatology.

UnitedHealthcare Community Plan considers clinical and surgical pathology consultation codes as included in an Evaluation and Management (E/M) service provided for the same patient on the same date of service. If billed with an E/M service, codes 80500-80502 and/or 88321-88325 are not separately reimbursable.

2014A UnitedHealthcare Community Plan E & M Codes for the Laboratory Rebundling Policy

Qualitative Laboratory Services (80100, 80101, or 80104)

Consistent with CMS guidelines, UnitedHealthcare Community Plan will not reimburse CPT codes 80100, 80101, or 80104, as HCPCS code G0431 or G0434 better describes the services being rendered for qualitative drug screenings.

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State Exceptions

Arizona Arizona Medicaid lines of business are excluded from the Qualitative Laboratory Services Section

Delaware Delaware Medicaid lines of business are excluded from the Qualitative Laboratory Services Section

Florida Florida Medicaid lines of business are excluded from the Qualitative Laboratory Services Section

Hawaii Hawaii Medicaid lines of business are excluded from the Qualitative Laboratory Services Section

Kansas Kansas Medicaid lines of business will be reimbursed for Qualitative Laboratory Services 80101 and 80104. However, CPT 80100 will not be reimbursed as the more appropriate HCPC code G0431 should be billed. Per Kansas State Regulations codes 84443, 85025, and 80053 can be billed separately and should not be bundled into panel code 80050.

Maryland Maryland Medicaid lines of business are excluded from the Qualitative Laboratory Services Section. Maryland allows payment of CPT 36416 when billed with an Evaluation and


CMS-1500


Management service.

Michigan Michigan follows CPT direction regarding panel codes and requires all components of a panel to be submitted before codes are combined into the corresponding panel code.

Nebraska Nebraska Medicaid lines of business are excluded from the Qualitative Laboratory Services Section

New Jersey New Jersey Medicaid lines of business will be reimbursed for Qualitative Laboratory Services 80101 and 80100. However, CPT 80104 will not be reimbursed as the more appropriate HCPC code G0434 should be billed.

New York New York Medicaid lines of business are excluded from the Qualitative Laboratory Services Section

Ohio Ohio follows CPT direction regarding panel codes and requires all components of a panel to be submitted before codes are combined into the corresponding panel code. Ohio allows payment of CPT 36416 when billed with an Evaluation and Management service.

Pennsylvania Pennsylvania Medicaid lines of business will be reimbursed for Qualitative Laboratory Services 80101 and 80104. However, CPT 80100 will not be reimbursed as the more appropriate HCPC code G0431 should be billed.

Rhode Island Rhode Island Medicaid lines of business are excluded from the Qualitative Laboratory Services Section

Texas Texas allows reimbursement for CPT code 99000. Texas Medicaid lines of business are excluded from the Qualitative Laboratory Services Section

Wisconsin Wisconsin allows payment of CPT 36416 when billed with an Evaluation and Management service for members ages 6 and under. Wisconsin allows reimbursement for CPT code 99000 & 99001. Wisconsin Medicaid lines of business are excluded from the Qualitative Laboratory Services Section

Definitions

Component Codes Identify individual tests that when performed together may comprise a panel.

Duplicate Laboratory Service

Identical or equivalent bundled laboratory Component Codes, submitted for the same patient on the same date of service on separate claim lines or on different claims regardless of the assigned Maximum Frequency per Day (MFD) value.

Non-Reference Laboratory Provider

A physician reporting laboratory procedures performed in their office or a pathologist.

Panel Codes Identify, for coding purposes, a group of tests commonly performed as a group or profile.

Physician Office Laboratory

A laboratory maintained by a physician or group of physicians for performing diagnostic tests in connection with the physician practice.

Precedence The fact, state, or right of preceding priority; priority claimed because of pre-


CMS-1500


eminence or superiority.

Purchased Diagnostic Tests

When one component (technical or professional) of a diagnostic test is purchased from a laboratory supplier by a physician or laboratory. Purchased Diagnostic Tests include laboratory or pathology services that are listed in the (CMS) National Physician Fee Schedule with a PC/TC indicator 1, 6, or 8. Purchased services do not apply to automated or manual laboratory services. When billed by the purchaser, the purchased service is identified with a modifier 90.

Reference Laboratory A laboratory certified to perform diagnostic and/or clinical tests independent of an institution or a physician's office. A Reference Laboratory can commonly be referred to as an independent laboratory.

Referring Laboratory A laboratory that has referred a Specimen or sample to a Reference Laboratory to perform the laboratory test. Services billed by Referring Laboratories for Reference Laboratories should use modifier 90 to identify the referred laboratory services.

Same Group Physician or Other Health Care Professional

All physicians and/or other health care professionals of the same group reporting the same Federal Tax Identification number.

Same Individual Physician or Other Health Care Professional

The same individual rendering health care services reporting the same Federal Tax Identification number.

Specimen Tissue or tissues that is (are) submitted for individual and separate attention, requiring individual examination and pathological diagnosis. Two or more such Specimens from the same patient (eg, separately identifiable endoscopic biopsies, skin lesions) are each appropriately assigned an individual code reflective of its proper level of service.

Questions and Answers

1

Q: What place of service should a Reference (Independent) Laboratory report when billing?

A: When billing, the place of service reported should be the location where the Specimen was obtained, For example, a specimen removed from a hospitalized patient and sent to the laboratory would be reported with Place of Service (POS) 21 or 22; a sample taken at a physician's office and referred to the laboratory would be reported with POS 11; if the reference laboratory did the blood drawing in its own setting, it should report POS 81.

2

Q: Will identical or equivalent laboratory Component Codes submitted on the same day for the same patient by the Same Group Physician or Other Health Care Professional be denied as Duplicate Laboratory Services?

A: No, identical or equivalent laboratory Component Codes are reimbursable when the appropriate repeat laboratory procedure modifier (modifier 59 or 91) is appended to the code(s) submitted.


CMS-1500


3

Q: Will consecutive or serial tests provided on the same day to the same patient by either physicians of the same group or multiple providers be denied as a Duplicate Laboratory Service?

A: No, consecutive or serial tests are reimbursable when the appropriate repeat laboratory procedure modifier (modifier 91) is appended to the codes submitted.

4

Q: In what circumstance(s) is it appropriate to report modifier 59 with a laboratory service?

A: Modifier 59 is appropriate when identifying procedures/services that are performed by the same individual or Same Group Physician or Other Health Care Professional for the same patient on the same day. Circumstances include:

Mutually exclusive procedures (e.g., a Panel Code and one of its individual Component Codes reported together).

Repeat laboratory services on Specimens from distinctly separate anatomic sites.

Repeat laboratory services for different species or strains.

5

Q: If a pathologist and a treating physician report identical codes for the same individual on the same date of service, how will the claim be reimbursed?

A: Only the pathologist will be reimbursed. The treating physician may also be reimbursed if modifier 59 or 91 is appropriately reported with the code(s) submitted to distinguish that it was a distinct or repeat laboratory service.

Attachments

2014A UnitedHealthcare Community Plan E& M Codes for the Laboratory Rebundling Policy

A list of evaluation and management codes applicable to the Laboratory Rebundling Policy.


A list of codes that have been assigned a Professional Component/ Technical Component (PC/TC) Indicator of 3 or 9. PC/TC Indicator 3: Technical Component Only code PC/TC Indicator 9: The concept of a professional/technical component does not apply These services are not reimbursable to a Reference Laboratory or Non-Reference Laboratory Provider in a facility setting.


A list of laboratory codes that have been assigned a Professional Component/ Technical Component (PC/TC) Indicator of 1, 6, or 8. PC/TC Indicator 1: Physician Service Codes (modifier TC and 26 codes) PC/TC Indicator 6: Laboratory Physician Interpretation Codes PC/TC Indicator 8: Physician Interpretation Codes These services are reimbursable as Purchased Diagnostic Tests when billed with a modifier 90.

Resources

Individual state Medicaid regulations, manuals & fee schedules

American Medical Association, Current Procedural Terminology ( CPT® ) Professional Edition and

associated publications and services

Centers for Medicare and Medicaid Services, CMS Manual System and other CMS publications and


CMS-1500


services

Centers for Medicare and Medicaid Services, Healthcare Common Procedure Coding System, HCPCS Release and Code Sets

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History

8/4/2014 Application Section: Removed Florida Medicaid and Rhode Island Medicaid and added “including, but not limited to” verbiage. State Exceptions Section Updated: Added information for Florida and Rhode Island.

5/19/2014 Application Section: Added verbiage stating this policy applies to UnitedHealthcare Community Plan Medicaid and Medicare products State Exceptions Section Updated: Added information for Kansas, Ohio and Maryland

3/31/2014 Disclaimer: Revised Laboratory Rebundling Section updated: added Medicare exclusion History prior to 1/1/2012 archived

3/30/2014 Policy Verbiage Change: Surgical and Clinical Pathology Consultations Section

2/15/2014 Policy Verbiage Addition: Qualitative Laboratory Services Policy Name Change: Laboratory Rebundling Policy changed to Laboratory Services Policy State Exceptions Section: Arizona, Delaware, Hawaii, Kansas, Maryland, Nebraska, New York, New Jersey, and Pennsylvania added. Texas and Wisconsin updated.

1/27/2014 Annual renewal of policy approved by United HealthCare Community & State Payment Policy Committee

1/8/2014 Annual renewal of policy approved by National Reimbursement Forum

1/1/2014 Annual Version Change. Policy Verbiage Changes: Duplicate Laboratory Charges section, Definitions and Question and Answer section, Question #2 newly added, original #2 renumbered to #3, original #3 removed, original #4 removed, #5 renumbered to updated #4, #5 newly added, and #6 and #7 removed. Policy Attachment Updates – Evaluation and Management Codes for the Laboratory Rebundling Policy, Laboratory Codes with a PC/TC Indicator 3 or 9, Purchased Laboratory Eligible Codes.

11/17/2013 State Specific section updated: Ohio added

4/7/2013 Policy Verbiage change: Application section added “qualified” Policy Attachment Updates: Laboratory Codes with a PC/TC Indicator 3 or 9

1/1/2013 Annual Version Change Policy Verbiage Change: Duplicate Laboratory Charges removed genetic testing modifier references, Modifier 90 description updated Policy Questions and Answers Change: Q&A 7 removed Policy Attachment Updates : Purchased Laboratory Eligible Codes, Laboratory Codes with a PC/TC Indicator 3 or 9 and Evaluation and Management Codes for the Laboratory Rebundling Policy

12/10/2012 Annual Renewal of Policy approved by United HealthCare Community & State Payment Policy Committee

11/12/2012 Policy Verbiage Change: Surgical and Clinical Pathology Consultations Section. Policy Definition Removed: Pathologist


CMS-1500


8/19/2012 Policy Verbiage Change: POS 24 removed from the Laboratory Services Performed in a Facility Setting section.

5/20/2012 Policy Attachment Updates: Laboratory Codes with a PC/TC Indicator 3 or 9 History Section: entries prior to 2/1/2010 archived

4/1/2012 Policy Verbiage Change: Changed modifier 77 to 91 in all sections.

1/1/2012 Annual Policy Version Change Policy Verbiage Change: Modifier section, Venipuncture section Policy Attachment Updates: Purchased Laboratory Eligible Codes, Laboratory Codes with a PC/TC Indicator 3 or 9, Genetic modifiers list added

1/30/2006 Policy Implemented by UnitedHealthcare Community & State

2014A UnitedHealthcare Community Plan E & M Codes for the Laboratory Rebundling Policy

92002 99226 99288 99341 99380 99412 99471 G0397

92004 99231 99291 99342 99381 99420 99472 G0402

92012 99232 99292 99343 99382 99429 99475 G0406

92014 99233 99304 99344 99383 99441 99476 G0407

99024 99234 99305 99345 99384 99442 99477 G0408

99201 99235 99306 99347 99385 99443 99478 G0425

99202 99236 99307 99348 99386 99444 99479 G0426

99203 99238 99308 99349 99387 99446 99480 G0427

99204 99239 99309 99350 99391 99447 99481 G0436

99205 99241 99310 99354 99392 99448 99482 G0437

99211 99242 99315 99355 99393 99449 99485 G0438

99212 99243 99316 99356 99394 99450 99486 G0439

99213 99244 99318 99357 99395 99455 99487 G0463

99214 99245 99324 99358 99396 99456 99488 M0064

99215 99251 99325 99359 99397 99460 99489 S0273

99217 99252 99326 99360 99401 99461 99495 S0274

99218 99253 99327 99366 99402 99462 99496 S0280

99219 99254 99328 99367 99403 99463 99499 S0281

99220 99255 99334 99368 99404 99464 0188T S0610

99221 99281 99335 99374 99406 99465 0189T S0612

99222 99282 99336 99375 99407 99466 G0101 S0613

99223 99283 99337 99377 99408 99467 G0245 S0620

99224 99284 99339 99378 99409 99468 G0246 S0621

99225 99285 99340 99379 99411 99469 G0396

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CMS-1500



80047 81310 82550 83805 85018 86580 87081 87631

80048 81315 82552 83825 85025 86590 87084 87632

80050 81316 82553 83835 85027 86592 87086 87633

80051 81317 82554 83840 85032 86593 87088 87640

80053 81318 82565 83857 85041 86602 87101 87641

80055 81319 82570 83858 85044 86603 87102 87650

80061 81321 82575 83861 85045 86606 87103 87651

80069 81322 82585 83864 85046 86609 87106 87652

80074 81323 82595 83866 85048 86611 87107 87653

80076 81324 82600 83872 85049 86612 87109 87660

80100 81325 82607 83873 85055 86615 87110 87661

80101 81326 82608 83874 85130 86617 87116 87797

80102 81330 82610 83876 85170 86618 87118 87798

80103 81331 82615 83880 85175 86619 87140 87799

80104 81332 82626 83883 85210 86622 87143 87800

80150 81340 82627 83885 85220 86625 87147 87801

80152 81341 82633 83887 85230 86628 87149 87802

80154 81342 82634 83915 85240 86631 87150 87803

80155 81350 82638 83916 85244 86632 87152 87804

80156 81355 82646 83918 85245 86635 87153 87807

80157 81370 82649 83919 85246 86638 87158 87808

80158 81371 82651 83921 85247 86641 87166 87809

80159 81372 82652 83925 85250 86644 87168 87810

80160 81373 82654 83930 85260 86645 87169 87850

80162 81374 82656 83935 85270 86648 87172 87880

80164 81375 82657 83937 85280 86651 87176 87899

80166 81376 82658 83945 85290 86652 87177 87900

80168 81377 82664 83950 85291 86653 87181 87901

80169 81378 82666 83951 85292 86654 87184 87902

80170 81379 82668 83970 85293 86658 87185 87903

80171 81380 82670 83986 85300 86663 87186 87904

80172 81381 82671 83987 85301 86664 87187 87905

80173 81382 82672 83992 85302 86665 87188 87906

80174 81383 82677 83993 85303 86666 87190 87910

80175 81400 82679 84022 85305 86668 87197 87912

80176 81401 82690 84030 85306 86671 87205 87999

80177 81402 82693 84035 85307 86674 87206 88000


CMS-1500



80178 81403 82696 84060 85335 86677 87209 88005

80180 81404 82705 84061 85337 86682 87210 88007

80182 81405 82710 84066 85345 86684 87220 88012

80183 81406 82715 84075 85347 86687 87230 88014

80184 81407 82725 84078 85348 86688 87250 88016

80185 81408 82726 84080 85360 86689 87252 88020

80186 81479 82728 84081 85362 86692 87253 88025

80188 81500 82731 84085 85366 86694 87254 88027

80190 81503 82735 84087 85370 86695 87255 88028

80192 81504 82742 84100 85378 86696 87260 88029

80194 81506 82746 84105 85379 86698 87265 88036

80195 81507 82747 84106 85380 86701 87267 88037

80196 81508 82757 84110 85384 86702 87269 88040

80197 81509 82759 84112 85385 86703 87270 88045

80198 81510 82760 84119 85397 86704 87271 88099

80199 81511 82775 84120 85400 86705 87272 88130

80200 81512 82776 84126 85410 86706 87273 88140

80201 81599 82777 84127 85415 86707 87274 88142

80202 82000 82784 84132 85420 86708 87275 88143

80203 82003 82785 84133 85421 86709 87276 88147

80299 82009 82787 84134 85441 86710 87277 88148

80400 82010 82800 84135 85445 86711 87278 88150

80402 82013 82803 84138 85460 86713 87279 88152

80406 82016 82805 84140 85461 86717 87280 88153

80408 82017 82810 84143 85475 86720 87281 88154

80410 82024 82820 84144 85520 86723 87283 88155

80412 82030 82930 84145 85525 86727 87285 88164

80414 82040 82938 84146 85530 86729 87290 88165

80415 82042 82941 84150 85536 86732 87299 88166

80416 82043 82943 84152 85540 86735 87300 88167

80417 82044 82945 84153 85547 86738 87301 88174

80418 82045 82946 84154 85549 86741 87305 88175

80420 82055 82947 84155 85555 86744 87320 88184

80422 82075 82948 84156 85557 86747 87324 88185

80424 82085 82950 84157 85597 86750 87327 88230

80426 82088 82951 84160 85598 86753 87328 88233

80428 82101 82952 84163 85610 86756 87329 88235


CMS-1500



80430 82103 82953 84202 85611 86757 87332 88237

80432 82104 82955 84203 85612 86759 87335 88239

80434 82105 82960 84206 85613 86762 87336 88240

80435 82106 82962 84207 85635 86765 87337 88241

80436 82107 82963 84210 85651 86768 87338 88245

80438 82108 82965 84220 85652 86771 87339 88248

80439 82120 82975 84228 85660 86774 87340 88249

80440 82127 82977 84233 85670 86777 87341 88261

81000 82128 82978 84234 85675 86778 87350 88262

81001 82131 82979 84235 85705 86780 87380 88263

81002 82135 82980 84238 85730 86784 87385 88264

81003 82136 82985 84244 85732 86787 87389 88267

81005 82139 83001 84252 85810 86788 87390 88269

81007 82140 83002 84255 85999 86789 87391 88271

81015 82143 83003 84260 86000 86790 87400 88272

81020 82145 83008 84270 86001 86793 87420 88273

81025 82150 83009 84275 86003 86800 87425 88274

81050 82154 83010 84285 86005 86803 87427 88275

81099 82157 83012 84295 86021 86804 87430 88280

81161 82160 83013 84300 86022 86805 87449 88283

81200 82163 83014 84302 86023 86806 87450 88285

81201 82164 83015 84305 86038 86807 87451 88289

81202 82172 83018 84307 86039 86808 87470 88720

81203 82175 83021 84311 86060 86812 87471 88738

81205 82180 83026 84315 86063 86813 87472 88740

81206 82190 83030 84375 86140 86816 87475 88741

81207 82205 83033 84376 86141 86817 87476 88749

81208 82232 83036 84377 86146 86821 87477 89050

81209 82239 83037 84378 86147 86822 87480 89051

81210 82240 83045 84379 86148 86825 87481 89055

81211 82247 83050 84392 86152 86826 87482 89125

81212 82248 83051 84402 86155 86828 87485 89160

81213 82252 83055 84403 86156 86829 87486 89190

81214 82261 83060 84425 86157 86830 87487 89220

81215 82270 83065 84430 86160 86831 87490 89230

81216 82271 83068 84431 86161 86832 87491 89398

81217 82272 83069 84432 86162 86833 87492 G0027


CMS-1500



81220 82274 83070 84436 86171 86834 87493 G0103

81221 82286 83071 84437 86185 86835 87495 G0123

81222 82300 83080 84439 86200 86849 87496 G0143

81223 82306 83088 84442 86215 86850 87497 G0144

81224 82308 83090 84443 86225 86860 87498 G0145

81225 82310 83150 84445 86226 86870 87500 G0147

81226 82330 83491 84446 86235 86880 87501 G0148

81227 82331 83497 84449 86243 86885 87502 G0306

81228 82340 83498 84450 86277 86886 87503 G0307

81229 82355 83499 84460 86280 86890 87510 G0328

81235 82360 83500 84466 86294 86891 87511 G0431

81240 82365 83505 84478 86300 86900 87512 G0432

81241 82370 83516 84479 86301 86901 87515 G0433

81242 82373 83518 84480 86304 86902 87516 G0434

81243 82374 83519 84481 86305 86904 87517 G0435

81244 82375 83520 84482 86308 86905 87520 G9143

81245 82376 83525 84484 86309 86906 87521 P2028

81250 82378 83527 84485 86310 86910 87522 P2029

81251 82379 83528 84488 86316 86911 87525 P2031

81252 82380 83540 84490 86317 86920 87526 P2033

81253 82382 83550 84510 86318 86921 87527 P2038

81254 82383 83570 84512 86329 86922 87528 P3000

81255 82384 83582 84520 86331 86923 87529 P7001

81256 82387 83586 84525 86332 86927 87530 Q0111

81257 82390 83593 84540 86336 86930 87531 Q0112

81260 82397 83605 84545 86337 86931 87532 Q0113

81261 82415 83615 84550 86340 86932 87533 Q0114

81262 82435 83625 84560 86341 86940 87534 Q0115

81263 82436 83630 84577 86343 86941 87535 S3620

81264 82438 83631 84578 86344 86945 87536 S3630

81265 82441 83632 84580 86352 86950 87537 S3645

81266 82465 83633 84583 86353 86960 87538 S3650

81267 82480 83634 84585 86355 86965 87539 S3652

81268 82482 83655 84586 86356 86970 87540 S3655

81270 82485 83661 84588 86357 86971 87541 S3708

81275 82486 83662 84590 86359 86972 87542 S3721

81280 82487 83663 84591 86360 86975 87550 S3800


CMS-1500



81281 82488 83664 84597 86361 86976 87551 S3840

81282 82489 83670 84600 86367 86977 87552 S3841

81287 82491 83690 84620 86376 86978 87555 S3842

81290 82492 83695 84630 86378 86985 87556 S3844

81291 82495 83698 84681 86382 86999 87557 S3845

81292 82507 83700 84702 86384 87001 87560 S3846

81293 82520 83701 84703 86386 87003 87561 S3849

81294 82523 83704 84704 86403 87015 87562 S3850

81295 82525 83718 84830 86406 87040 87580 S3852

81296 82528 83719 84999 86430 87045 87581 S3853

81297 82530 83721 85002 86431 87046 87582 S3854

81298 82533 83727 85004 86480 87070 87590 S3855

81299 82540 83735 85007 86481 87071 87591 S3861

81300 82541 83775 85008 86485 87073 87592 S3865

81301 82542 83785 85009 86486 87075 87620 S3866

81302 82543 83788 85013 86490 87076 87621 S3870

81303 82544 83789 85014 86510 87077 87622 S3890

81304

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83020 86256 88108 88177 88312 88343 88362 88399

84165 86320 88112 88182 88313 88346 88365 89060

84166 86325 88120 88199 88314 88347 88367 G0416

84181 86327 88121 88300 88319 88348 88368 G0417

84182 86334 88125 88302 88323 88349 88371 G0418

85060 86335 88160 88304 88331 88355 88372 G0419

85390 87164 88161 88305 88332 88356 88380 G0452

85576 87207 88162 88307 88333 88358 88381 G0461

86153 88104 88172 88309 88334 88360 88387 G0462

86255 88106 88173 88311 88342 88361 88388

Documents

Laboratory Services Policy...that you are reimbursed based on the code or codes that correctly describe the health care services provided. UnitedHealthcare Community Plan reimbursement