Laboratory Services - Miscellaneous

Billing Multiple Dates of Service on a Single Claim

In order process lab claims correctly for Medicare Advantage plans, only a single date of service can be billed on each claim. For HMSA's Preferred Provider Plans, the State Plan, QUEST Integration, Federal Plan 87, HMSA Plan for Postal Service Employees, and HMO commercial plans, multiple dates of service can be billed on a single claim.

Modifier 91 for Repeat Diagnostic Tests

Repeat diagnostic tests should be indicated with Modifier Code 91 appended to subsequent occurrences of an individual test. Modifier 91 must be appended to the first appearance of the individual test code if the individual test also is represented within a panel billed for the same date of service. Otherwise, the test code will be processed as a duplicate and not be paid.

HMSA recognizes the Model Compliance Plan for Clinical Laboratories issued by the U.S. Department of Health & Human Services Office of Inspector General (HHS OIG) as a description of clinical laboratory best practices.

Access the Model Compliance Plan [PDF].

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