September 7, 2023
Effective with claim dates of service on and after December 11, 2023, the Modifier 90 payment policy will apply to facility claims.
Lab services sent to an independent reference laboratory for analysis must be billed to Premera by the independent reference laboratory that performed the analysis. Modifier 90 must be appended to these tests from the analyzing reference laboratory to identify them as referred laboratory services.
Lab services appended with Modifier 90 billed on either a professional or a facility claim form and submitted by a non-laboratory provider will be denied reimbursement.
Review the Modifier 90 – reference (outside) laboratory policy.