Modifier 90 (Pass-Through) — Reimbursement Policy
Governs billing and reimbursement for laboratory services billed with Modifier 90 (pass-through billing) for Blue Cross Blue Shield - Maine members, affecting providers submitting claims for office (POS 11) laboratory tests.
No material clinical or coverage changes in this revision.
Modifier 90 Billing and Coverage Criteria
Modifier 90 billing criteria
Billing and reimbursement rules for Modifier 90 (pass-through billing):
Modifier and Reimbursement Coding
| Modifier 90 | Pass-through billing modifier when laboratory procedures are performed by a party other than the treating or reporting provider |
Provider Billing Actions and Denial Risks
Denial risk when billing Modifier 90 in POS 11
Claims appended with Modifier 90 in an office place of service (11) will be denied unless provider, state, federal, or CMS contracts and/or requirements indicate otherwise.
Definitions
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