Modifier Code 90

Modifier code 90 is added to a procedure code by a laboratory to indicate that the specimen was tested by a party other than the treating or reporting physician.

HMSA recognizes claims for a laboratory service only when billed by the provider furnishing the services.

Claims Filing Information

Referring physicians should not submit claims containing modifier code 90. If a referring physician wishes to bill for the test to obtain a rejection that can be submitted to another carrier, the physician should append modifier 90 to the code for the test.

Example

A claim is submitted by a general practice physician for cervical smear services performed by an outside laboratory. It should be billed as:
88150- 90 - Cytopath smears

HMSA Payment Guidelines

HMSA will not allow payment to the physician for services performed by an outside laboratory. This laboratory service should be billed to HMSA directly by the laboratory performing the test.

Note: Collection, handling and/or conveyance of a specimen for transfer from the physician's office to a laboratory is considered an integral part of the evaluation and management (E/M) visit and should not be billed separately to HMSA or the member.

Revision History