{"id":10042,"date":"2019-11-20T15:39:40","date_gmt":"2019-11-20T10:09:40","guid":{"rendered":"https:\/\/www.medicalbillersandcoders.com\/blog\/?p=10042"},"modified":"2026-10-12T19:07:11","modified_gmt":"2026-10-12T13:37:11","slug":"reimbursement-guidelines-for-modifiers-90","status":"publish","type":"post","link":"https:\/\/www.medicalbillersandcoders.com\/blog\/reimbursement-guidelines-for-modifiers-90\/","title":{"rendered":"Reimbursement Guidelines for Modifier 90"},"content":{"rendered":"<p><strong>Reference (Outside) Laboratory:<\/strong> Add Modifier 90 to the usual procedure code when a party other than the treating or reporting physician performs the laboratory procedure. In the <a href=\"https:\/\/www.medicare.gov\/\">Medicare<\/a> program, independent clinical laboratories use this modifier when they refer tests to a reference laboratory for analysis.<\/p>\r\n<h2>Key Takeaways<\/h2>\r\n<ul>\r\n<li>Modifier 90 tells the payer that an outside (reference) lab performed the test, even though the physician or referring lab reports it.<\/li>\r\n<li>It does not bypass clinical edits, subsets, or bundling rules.<\/li>\r\n<li>On the claim, mark Item 20 &#8220;Yes,&#8221; enter the purchase price, complete Item 32 (NPI, name, address), and list both CLIA numbers.<\/li>\r\n<li>Never append it to anatomic pathology services or the drawing fee (CPT 36415). Handling fees (CPT 99000\/99001) are not separately payable.<\/li>\r\n<li>Bill referred tests and in-house tests on separate claims to avoid denials.<\/li>\r\n<\/ul>\r\n<p>A physician or clinic uses the modifier when an outside or reference laboratory performs a patient&#8217;s lab tests. It shows that although the physician reports the test, a separate laboratory performed the actual testing component.<\/p>\r\n<p>Modifier 90 also applies when the outside lab bills the physician for the service. For example, a physician orders a CBC in the office, draws the blood, and sends the specimen to an outside laboratory. When you bill outside reference laboratory services with this modifier:<\/p>\r\n<ul>\r\n<li>The reference laboratory modifier does not bypass clinical edits, subsets, bundling, etc.<\/li>\r\n<li>If the provider performs some blood and\/or serum lab procedures in-house and sends others to an outside lab, CPT 36415 is not eligible for separate reimbursement.<\/li>\r\n<li>Payers do not reimburse CPT codes 99000 and 99001 (handling fees) separately.<\/li>\r\n<\/ul>\r\n<h2>Correct Use of Modifier 90<\/h2>\r\n<ol>\r\n<li>An outside laboratory, unrelated to the treating\/reporting physician, performs the procedure.\r\n<ul>\r\n<li>In most cases, the lab that furnishes the service bills the claim.<\/li>\r\n<\/ul>\r\n<\/li>\r\n<li>One lab may bill for a service that another lab performed.\r\n<ul>\r\n<li><strong>Referring lab<\/strong> \u2013 sends a specimen to another laboratory for testing.<\/li>\r\n<li><strong>Reference lab<\/strong> \u2013 receives a specimen from another lab and performs one or more tests on it.<\/li>\r\n<\/ul>\r\n<\/li>\r\n<li>Append modifier 90 to the referred laboratory test code.\r\n<ul>\r\n<li>Mark Item 20 &#8220;Yes&#8221; for outside lab.<\/li>\r\n<li>Enter the purchase price under Item 20 charges.<\/li>\r\n<li>Complete Item 32 with the NPI, name, and address of the lab that performed the test.<\/li>\r\n<\/ul>\r\n<\/li>\r\n<li>Include two different Clinical Laboratory Improvement Amendments (CLIA) numbers on the claim:\r\n<ul>\r\n<li>The billing provider&#8217;s information<\/li>\r\n<li>The laboratory that performed the services (reference lab)<\/li>\r\n<\/ul>\r\n<\/li>\r\n<li>Bill referred tests and in-house tests on separate claims.<\/li>\r\n<li>If there are no purchased services, leave Item 20 blank.<\/li>\r\n<\/ol>\r\n<h2>When Not to Use Modifier 90<\/h2>\r\n<ul>\r\n<li>Do not report it with anatomic pathology services.<\/li>\r\n<li>Do not append it to the drawing fee (CPT 36415).<\/li>\r\n<li>A reference lab cannot refer the test out to another lab.<\/li>\r\n<\/ul>\r\n<h3>Medical Billers and Coders<\/h3>\r\n<p>Serving more than 40 specialties, <strong>Medical Billers and Coders (MBC)<\/strong> handles services ranging from <a href=\"https:\/\/medicalbillersandcoders.com\/revenue-management-services.aspx\">revenue cycle management<\/a> to <a href=\"https:\/\/www.medicalbillersandcoders.com\/ICD-10.aspx\">ICD-10<\/a> testing solutions. Our main goal is to help physicians find skilled billers and coders.<\/p>\r\n<p><strong>Struggling with Modifier 90 denials or reference lab billing? <a href=\"https:\/\/www.medicalbillersandcoders.com\/contact-us.aspx?utm_source=contact-us-sab&amp;utm_medium=submission%28sab%29&amp;utm_campaign=submission%28sab%29&amp;utm_id=contact-us-sab&amp;utm_term=26%2F08%2F2026SAB&amp;utm_content=%28SAB%29\">Contact Medical Billers and Coders today<\/a> for expert lab billing and coding support.<\/strong><\/p>\r\n<h2><strong>FAQs:<\/strong><\/h2>\r\n\r\n<div class=\"schema-faq wp-block-yoast-faq-block\">\r\n<div id=\"faq-question-1746609279175\" class=\"schema-faq-section\"><strong class=\"schema-faq-question\">1: What is Modifier 90 used for in medical billing?<\/strong>\r\n<p class=\"schema-faq-answer\">It indicates that an outside or reference laboratory, rather than the treating or reporting physician, performed the laboratory tests.<\/p>\r\n<\/div>\r\n<div id=\"faq-question-1746609296405\" class=\"schema-faq-section\"><strong class=\"schema-faq-question\">2: When should I use this modifier?<\/strong>\r\n<p class=\"schema-faq-answer\">Use it when you refer laboratory tests to an outside lab and bill for the services that lab performed.<\/p>\r\n<\/div>\r\n<div id=\"faq-question-1746609307075\" class=\"schema-faq-section\"><strong class=\"schema-faq-question\">3: Can I use it for all laboratory services?<\/strong>\r\n<p class=\"schema-faq-answer\">No. Do not report it with anatomic pathology services or the drawing fee (CPT 36415).<\/p>\r\n<\/div>\r\n<div id=\"faq-question-1746609318885\" class=\"schema-faq-section\"><strong class=\"schema-faq-question\">4: How should I submit claims with Modifier 90?<\/strong>\r\n<p class=\"schema-faq-answer\">Include the reference lab\u2019s information and CLIA number, and mark Item 20 to show that you used an outside lab.<\/p>\r\n<\/div>\r\n<div id=\"faq-question-1746609330781\" class=\"schema-faq-section\"><strong class=\"schema-faq-question\">5: What happens if I use the modifier incorrectly?<\/strong>\r\n<p class=\"schema-faq-answer\">Incorrect use can lead to claim denials or rejections, because payers rely on the modifier to identify services an outside lab performed.<\/p>\r\n<\/div>\r\n<\/div>\r\n","protected":false},"excerpt":{"rendered":"<p>Reference (Outside) Laboratory: Add Modifier 90 to the usual procedure code when a party other than the treating or reporting physician performs the laboratory procedure. In the Medicare program, independent clinical laboratories use this modifier when they refer tests to a reference laboratory for analysis. Key Takeaways Modifier 90 tells the payer that an outside [&hellip;]<\/p>\n","protected":false},"author":6,"featured_media":10043,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[2],"tags":[746,921,922,80,747,359,737,46,749,47,750,751,15,417,162,9,11,64,16,146,192,753,150,754,1159,1160,1535,1161,1281,1590,2091,1124,418,144,815,816,58,27,1125],"class_list":["post-10042","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-medical-billing-services","tag-billing-services-for-doctors","tag-coronavirus","tag-covid-19","tag-cpt-codes","tag-cpthcpcs","tag-dme-billing-services","tag-e-m-codes","tag-ehr","tag-em","tag-emr-ehr-health-it","tag-general-surgery-billing","tag-hcpcs-code","tag-medical-billing","tag-medical-billing-agencies","tag-medical-billing-and-coding-services","tag-medical-billing-companies","tag-medical-billing-outsourcing","tag-medical-billing-practices","tag-medical-billing-service","tag-medicare-2","tag-medicare-medicaid-services","tag-medicare-billing","tag-medicare-claims","tag-modifier","tag-modifier-25","tag-modifier-50","tag-modifier-51","tag-modifier-58","tag-modifier-59","tag-modifier-79","tag-modifier-90","tag-ncci","tag-online-medical-billing","tag-outsource-medical-billing","tag-outsourced-medical-billing-company","tag-outsourced-medical-billing-services","tag-rcm","tag-revenue-cycle-management-2","tag-services-american-healthcare-billing-services"],"yoast_head":"<!-- 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