Lab Tests Performed in Physician’s Offices When performing
laboratory tests in the physician’s office:
1. The Physician must be CLIA certified to perform the test,
2. The Physician must have the appropriate equipment to
perform the test, and
3. The Physician’s office bills for the tests performed but
not the collection fee.
When specimens are sent to an outside lab:
1. The Physician’s office should not bill the laboratory
code, and
2. The Physician’s office may bill a collection fee with a
“90” modifier for blood specimens
Lead Levels
Procedure Code 83655 (Lead) should only be billed when the
office has the equipment to perform the test. When collecting a specimen only
and then sending the blood sample to an outside lab for analysis, you must bill
Procedure Code 36415 with modifier 90. The utilization of procedure code 36415-90 will enable you to receive a collection and
handling fee for the specimen obtained.
Procedure code 36415-90 should not be billed when lab
procedures are performed in the office. The appropriate lab procedure code(s)
must be billed when actually performing the lab test. Again, the correct
equipment must be utilized to perform the test. These services are subject to
postpayment review. Medical record documentation must support the performance
and medical necessity of the laboratory test.
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