CurrentBlue Cross Blue Shield - MainePolicy C-21001

Non-Patient Laboratory Services - Facility

Governs reimbursement for non-patient laboratory services billed on facility UB-04 claims (type of bill 014X) for Anthem Blue Cross and Blue Shield members; affects facility providers submitting such claims. Exemptions for certain markets are noted.

Policy Summary

PayerBlue Cross Blue Shield - Maine

PolicyNon-Patient Laboratory Services - Facility

Policy CodePolicy C-21001

Change TypeNo material change

Effective DateAug 30, 2022

Next Review DateN/A

Key ActionDo not bill non-patient laboratory services on a UB-04 with type of bill 014X for reimbursement unless provider, state, or federal contracts require otherwise.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

014Xbilling form/type addressed

KY, NH, WImarkets excluded

Standard codingcoding requirement

CMS / Optumreferences

Non-Patient Laboratory Services Coverage

Non-Patient Laboratory Services reimbursement criteria

Covered when ALL of the following apply:

The Health Plan does not allow reimbursement for non-patient laboratory services when reported on a UB-04 with type of bill 014X unless provider, state, or federal contracts and/or requirements indicate otherwise.

Exceptions (market-level)

Kentucky is exempt from this policy.
New Hampshire is exempt from this policy.
Wisconsin is exempt from this policy.

Policy Summary

PayerBlue Cross Blue Shield - Maine

PolicyNon-Patient Laboratory Services - Facility

Policy CodePolicy C-21001

Change TypeNo material change

Effective DateAug 30, 2022

Next Review DateN/A

Key ActionDo not bill non-patient laboratory services on a UB-04 with type of bill 014X for reimbursement unless provider, state, or federal contracts require otherwise.

SourceLink

On This Page

Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.

Billing Restrictions and Provider Requirements

Billing Rule

Do not bill non-patient lab services on UB-04 type of bill 014X

Do not bill non-patient laboratory services for reimbursement on a UB-04 with type of bill 014X unless provider, state, or federal contracts or requirements indicate otherwise. Standard correct coding applies.

Claims submitted on UB-04 type of bill 014X for non-patient laboratory services will not be reimbursed except where overridden by provider, state, or federal contracts/requirements.
Ensure standard correct coding practices are followed when reporting services.

Key Definitions

Non-Patient — definition

TermNon-Patient

DefinitionA member that is neither an inpatient nor an outpatient of a hospital but has a specimen that is submitted for analysis to a hospital and the member is not physically present at the hospital.

RelevanceUsed to identify specimens billed as non-patient laboratory services on facility claims (UB-04 type of bill 014X).

Type of Bill — definition / relevance

TermType of Bill

DefinitionA four-digit alphanumeric code that provides three specific pieces of information after a leading zero: the type of facility, the type of care, and the sequence of this bill in the episode of care (frequency).

RelevanceSpecifies billing context for facility claims; policy applies to UB-04 reports with type of bill 014X.

OpenPayer

Non-Patient Laboratory Services - Facility

Non-Patient Laboratory Services Coverage

Coding Expectations

Billing Restrictions and Provider Requirements

Key Definitions