CPT Modifier 91

Description
Repeat clinical diagnostic laboratory test.

Guidelines/Instructions
CPT modifier 91 must be submitted with services that meet these criteria, regardless of whether the test is also submitted with HCPCS modifier AY.  
  • This modifier may not be submitted when tests are rerun to confirm initial results. This is due to testing problems with specimens or equipment or for any other reason when a normal, one-time reportable result is all that is required.
  • This modifier may not be used when other codes describe a series of test results (e.g., glucose tolerance tests)
  • For clinical laboratory tests ordered by an ESRD facility, these tests must be submitted with CPT modifier 91 if any single service (same CPT code) is ordered for the same patient, the specimen is collected more than once in a single day, and the service is medically necessary  

Reference: IOM Pub 100-4, Chapter 16, Section 100.5.1.

Contact Palmetto GBA JM Part B Medicare

Email Part B

Contact a specific JM Part B department

Provider Contact Center: 855-696-0705

TDD: 866-830-3188

Other Palmetto GBA Sites

Palmetto GBA Home

DMEPOS Competitive Bidding Program

Jurisdiction J Part A MAC

Jurisdiction J Part B MAC

Jurisdiction M Part A MAC

Jurisdiction M Part B MAC

Jurisdiction M Home Health and Hospice MAC

MolDX

National Supplier Clearinghouse MAC

PDAC

RRB Specialty MAC Providers

RRB Specialty MAC Beneficiaries

Anonymous

 

Click to Chat Now