Modifier For Lab Services3/5/2021
In other words, labs run labs - and thats what they bill for.Once the tests are done, the lab gives the results to the doctor.The doctor then uses these to assist in any medical decision-making.This means that the majority of the people who actually work in a lab and run the tests are lab technicians who run lab samples.
Sometimes there are entire labs that are devoted to only billing labs, rather than performing them. If this is the case then the lab will also bill for these EM services. These types of labs can include tests like urinalysis, complete blood count, and mono spot tests. ![]() ![]() From reading of the 2015 OPPS Final Rule it appears the intent of this modifier is mainly to gather information on off-campus physician offices and clinics operating as hospital provider-based departments. The answer we received from Tiffany Swygert with CMS is that, It applies to all services paid under the OPPS that are furnished in an off-campus provider based department of a hospital except for remote locations, satellite facilities and EDs. ![]() Another common outpatient service not paid under OPPS is laboratory services when they are non-patient services or the only outpatient services performed. In this situation, most clinical lab services are paid under the Clinical Laboratory Fee Schedule (CLFS) and based on the same logic would not require a PO modifier. However, lab services furnished with other outpatient services are packaged services which means they are paid under OPPS although there is no separate payment.
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