Modifier 90 Edit Extending to Facility Claims

  • October 15, 2020

    The current payment policy for Modifier 90-Reference (Outside) Laboratory has been revised to include facility claims billing modifier 90 appended to lab test codes. Modifier 90 appended to a lab code (80000 series of CPT codes) indicates the lab procedure was performed by an outside party other than the treating or reporting provider. Lab work must be billed/submitted directly by the lab performing the lab test.

    Effective with dates of service January 13, 2021 and after, Premera will no longer reimburse any laboratory test appended with modifier 90 submitted on a facility claim form, either a UB04/CMS-1450 paper claim or an 837I electronic claim. The laboratory service must be submitted directly to Premera by the provider who performed the laboratory test. Reimbursement will be made directly to the laboratory that performed the service(s) for those laboratory services covered by the member’s benefits.

    Please review the revised Payment Policy for further details.

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