Lab test performed in office and outside lab - what is the difference

Lab Tests Performed in Physician’s Offices When performing laboratory tests in the physician’s office:

1. The Physician must be CLIA certified to perform the test,
2. The Physician must have the appropriate equipment to perform the test, and
3. The Physician’s office bills for the tests performed but not the collection fee.

When specimens are sent to an outside lab:

1. The Physician’s office should not bill the laboratory code, and
2. The Physician’s office may bill a collection fee with a “90” modifier for blood specimens

Lead Levels
Procedure Code 83655 (Lead) should only be billed when the office has the equipment to perform the test. When collecting a specimen only and then sending the blood sample to an outside lab for analysis, you must bill Procedure Code 36415 with modifier 90. The utilization of procedure
code 36415-90 will enable you to receive a collection and handling fee for the specimen obtained.

Procedure code 36415-90 should not be billed when lab procedures are performed in the office. The appropriate lab procedure code(s) must be billed when actually performing the lab test. Again, the correct equipment must be utilized to perform the test. These services are subject to postpayment
review. Medical record documentation must support the performance and medical necessity of the laboratory test.

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