Starting July 01, 2020-free standing and outpatient hospital laboratory claims must contain the code for the requested test (your unique code*), in addition to the CPT/HCPCS code.
Definition: Unique code-is the code that your laboratory has assigned to the particular test.
Exceptions to this policy:
-Laboratory test Services requiring notification/prior authorization by Genetic an Molecular Lab Testing Notification/Prior Authorization Process.
-Laboratory test services requiring placement of Nation Institute of Health Genetic Testing Registry ID(per UHC Pathology Reimbursement policy)
-Laboratory test services rendered by outpatient physician office laboratories (i.e. POS 11)
If the claims do not have your unique test code, for the applicable laboratory services, the claims will be REJECTED.
If the claim is REJECTED you may NOT balance bill the member.
Where should the test code be placed?
Please click here on the link to visit the Reference Table.