Here are the latest updates to our payment policies. You’ll need to log in to see the policy updates.
October 15, 2020
Summary of Policy Updates:
Modifier 90 – Reference (Outside) Laboratory
The current policy is being expanded to include facility claims billing modifier 90 on lab test codes (80000 series of CPT codes). This will indicate that the lab procedure was performed by an outside party other than the treating or reporting provider.
Effective with dates of service January 13, 2021 and after, Premera will no longer reimburse any lab test appended with modifier 90 when submitted on a facility claim. Reimbursement will be made directly to the lab that performed the lab test(s) covered by member benefits.