HMSA's Medicare-based plans allow for the separate payment of venipuncture under Medicare's guidelines.
HMSA's Commercial plans allow for the separate payment of venipuncture CPT codes 36415 and 36416 at the outpatient laboratory benefit* when billed with a covered clinical laboratory test. Please be aware that CPT codes 36415 and 36416 are subject to system bundling edits and are not always separately payable from the associated laboratory procedures. Payment for CPT codes 36415 and 36416 will not be made if the associated clinical laboratory test is not covered.
*Beginning July 1, 2017, for non-grandfathered plans, when the venipuncture is associated with an Affordable Care Act (ACA) recommended laboratory test, please append modifier 33 to the venipuncture code. Appending modifier 33 will inform HMSA that the venipuncture is related to an ACA Preventive service and when the service is rendered by a participating provider, the member will have no cost share. For a list of ACA compliant plans refer to the following page:
Coverage Codes for Non-ACA-Compliant Health Plans
Refer to the following Preventive Health Guidelines for a list of ACA recommended laboratory services.
- Preventive Health Guidelines - Men
- Preventive Health Guidelines - Newborns and Children
- Preventive Health Guidelines - Prenatal Care
- Preventive Health Guidelines - Women
Revision History
| Date | Nature of Revision |
|---|---|
| 08/03/2026 | Migrated to new platform. |