Wiki Outside labs with 90 modifier

[agnowlin]

I'm hoping to get some help with this as I am having issues finding the magic combination to get these paid. Our office draws the blood for the labs. I bill with QW if it is covered under our CLIA# and with a modifier 90 if it needs to be covered under the outside labs CLIA#. The outside lab DOES NOT submit to insurance. We are billed for each lab processed so the office is the only one billing the insurance for these labs. I can not for the life of me get the 90 modifier labs to go out and process. We only accept Medicaid plans also. A question I have is should our CLIA# be attached to the ones that I bill a QW on and then the CLIA# be on the ones that has the 90 modifier and if so how does that work on the electronic side of the claim? Where should this info go? I'm praying it is an error on the Athena side that the CLIA just isn't in the correct place but I will take any suggestions or help I can get.

 

[andersona1229]

I do lab billing and deal with modifier 90 at times. My lab mainly does UDT, but we do a limited number of blood and molecular tests. I'm also the Medicaid/MCO guru of my department, and based on your location, I'm going to assume it's NC Medicaid with some SC mixed in? There are some blood tests that we don't do, and those are forwarded to another lab. We then bill with modifier 90. However, some payers won't accept -90 at all. For example, Primewest MCO in Minnesota won't even accept a claim with -90 on it; they reject it outright.

What CPTs are you billing with the modifier?