CurrentOscar HealthPolicy N/A

Venipuncture and Blood Specimen Collection Reimbursement

Defines Oscar Health reimbursement rules for venipuncture, capillary blood specimen collection from access devices/catheters, and laboratory handling services for professional, facility, and telehealth claims; affects providers billing Oscar Health.

Policy Summary

PayerOscar Health

PolicyVenipuncture and Blood Specimen Collection Reimbursement

Policy CodePolicy N/A

Change TypeNo material change

Effective Date04/01/2025

Next Review Date04/2026

Key ActionDo not bill venipuncture or collection codes with telehealth place of service 02 or 10; these are not reimbursed.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

onecollection fee per specimen

36400–36416venipuncture codes denied with same-day E/M

36591,36592collection codes denied on professional claim with non-lab services

99000,P9603handling/transport not reimbursed

02,10telehealth POS excluded

Policy Summary

PayerOscar Health

PolicyVenipuncture and Blood Specimen Collection Reimbursement

Policy CodePolicy N/A

Change TypeNo material change

Effective Date04/01/2025

Next Review Date04/2026

Key ActionDo not bill venipuncture or collection codes with telehealth place of service 02 or 10; these are not reimbursed.

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.

Reimbursement Criteria

Reimbursement and denial criteria by claim type and context.

Professional claims

Only one collection fee allowed per specimen type per patient encounter regardless of number of specimens drawn.
Venous and capillary blood collection reimbursed once per patient per date of service when reported by the same provider.
Deny venipuncture codes 36400, 36405, 36406, 36410, 36415, 36416 when billed by the same provider on a professional claim on the same day as E/M codes 99202-99205 or 99211-99215.
Deny collection codes 36591, 36592 on a professional claim when reported with services beyond laboratory services (CPT range 80000-89999).
Codes for specimen handling/transport (99000, 99001, P9603, P9604) are included in provider management and are not eligible for separate reimbursement.

Facility claims

Venipuncture and collection of blood specimens from an access device or catheter (36400–36416, 36591, 36592) are considered included in the facility payment and are denied for separate reimbursement when billed on a facility claim.
Codes for specimen handling/transport (99000, 99001, P9603, P9604) are included in facility management and are not eligible for separate reimbursement.

Telehealth

Do not reimburse venipuncture and collection codes (36400–36416, 36591, 36592) when reported with a telehealth place of service (02 or 10).

Venipuncture, Collection, and Handling Codes

Venipuncture and specimen handling codesCPTCovered

36400	Venous blood collection by venipuncture
36405	Venous blood collection (alternate descriptor)
36406	Venous blood collection (alternate descriptor)
36410	Venous blood collection (alternate descriptor)
36415	Collection of blood by venipuncture
36416	Collection of blood by venipuncture (alternate)
36591	Capillary blood collection from access device or catheter
36592	Capillary blood collection from access device or catheter (alternate)
99000	Handling/transport of specimen
99001	Handling/transport of specimen (alternate)

1–10 of 12

1/2

Venipuncture and specimen handling codes - Not eligible for separate reimbursement in facility/telehealth contextsmixedNot Covered

36400	Venous blood collection by venipuncture
36405	Venous blood collection (alternate descriptor)
36406	Venous blood collection (alternate descriptor)
36410	Venous blood collection (alternate descriptor)
36415	Collection of blood by venipuncture
36416	Collection of blood by venipuncture (alternate)
36591	Capillary blood collection from access device or catheter
36592	Capillary blood collection from access device or catheter (alternate)
99000	Handling/transport of specimen
99001	Handling/transport of specimen (alternate)

1–10 of 12

1/2

Coding threshold — collection fee frequency

Collection fee frequencyOne collection fee allowed per specimen type per patient encounter (1 per specimen type per patient encounter).

Billing Guidance & Denial Risks

Denial Risk

Prior Authorization / Denial Risk — Professional billing

Venipuncture and specimen collection have specific denial conditions when billed on professional claims. Oscar will deny venipuncture codes when billed by the same provider on a professional claim on the same day as Evaluation and Management codes 99202-99205 or 99211-99215, and will deny collection codes on professional claims when reported with services beyond just laboratory services (CPT® range 80000-89999). Handling/conveyance/travel allowance codes (99000, 99001, P9603, P9604) are not eligible for separate reimbursement and will be denied.

Denied venipuncture CPTs: 36400, 36405, 36406, 36410, 36415, 36416
Denied collection CPTs on professional claim with non-lab services: 36591, 36592
Not separately reimbursed: 99000, 99001, P9603, P9604

Denial Risk

Prior Authorization / Denial Risk — Facility billing

Facility claims: venipuncture and specimen collection are included in the facility payment and are not allowed for separate reimbursement — facility-billed venipuncture or collection CPTs will be denied. Handling/conveyance/travel allowance codes (99000, 99001, P9603, P9604) are also not eligible for separate reimbursement on facility claims.

Facility-denied CPTs: 36400, 36405, 36406, 36410, 36415, 36416, 36591, 36592
Not separately reimbursed on facility claims: 99000, 99001, P9603, P9604

Billing Rule

Billing Rule — Telehealth place of service

Telehealth place of service rules: venipuncture and collection of blood specimens (including from access devices or catheters) are not reimbursed when reported with a telehealth place of service (POS 02 or POS 10).

Telehealth-denied CPTs when billed with POS 02 or 10: 36400, 36405, 36406, 36410, 36415, 36416, 36591, 36592
Applies to venipuncture, capillary collection, and specimen collection from access devices/catheters

Key Definitions

Venipuncture and specimen collection — definitions

Venipuncture — definitionVenous blood collection by venipuncture reimbursed once per patient per date of service when reported by the same provider.

Capillary collection from access devices/cathetersCapillary blood specimen collection from an access device or catheter (e.g., codes 36591, 36592) for laboratory testing; reimbursed under the same per‑patient/per‑date limits and subject to denial rules on professional claims when reported with services beyond laboratory services.

Specimen collection services — facility stanceVenipuncture and collection of blood specimens from an access device or catheter are considered included in the facility payment and are not eligible for separate reimbursement on facility claims.

Professional claim handlingVenous and capillary collection reimbursed once per provider per date of service; venipuncture denied if billed same day by same provider with specified E/M codes.

Laboratory handling services — definitions

Laboratory handling services — inclusionHandling, conveyance, and travel allowance for pickup of laboratory specimens are considered included in provider or facility management and are not eligible for separate reimbursement (codes 99000, 99001, P9603, P9604).

Professional claim noteOn professional claims, codes for handling/transport (99000, 99001) and pickup/travel (P9603, P9604) are not separately reimbursable.

Facility claim noteOn facility claims, specimen handling and conveyance are included in the facility payment; handling/transport and pickup/travel codes are denied for separate reimbursement.