Can an independent laboratory bill both non-referred (i.e., self-reported) and referred services on the same CMS-1500 (02/12) claim form?

Answer:
No. Non-referred and referred laboratory tests cannot be billed on the same paper claim. When a billing laboratory performs some laboratory tests (non-referred) and refers some testing to another laboratory, it must submit two separate claims: one claim for non-referred tests performed by the billing lab, and the other for referred tests performed by the reference lab. The tests performed by the reference lab must be billed with CPT modifier 90. A paper claim that contains both non-referred and referred tests will be rejected as unprocessable.

If billing for services that have been referred to more than one laboratory, the referring laboratory must submit a separate claim for each laboratory to which services were referred (unless one or more of the reference laboratories are separately billing Medicare).

Resource: IOM 100-04, Chapter 16, Sections 40.1.1.1 (PDF, 569 KB)

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