Posted in BCBS Empire NY, Training, Updates

BCBS NY Medicaid: New Policy-Pass-through and Outside Laboratory billing

This reimbursement policy applies to Empire BCBS Health Plus members. The new reimbursement policy will become effective for DOS on 10/01/2021 and thereafter.


Empire BlueCross BlueShield HealthPlus does not allow pass-through billing for lab services. Claims appended with Modifier 90 and an office place of service will be denied unless provider, state, federal or CMS contracts and/or requirements indicate otherwise.


Reimbursement:

Empire BCBS HealthPlus will reimburse 100% of the applicable fee schedule or contracted/negotiated rate to the diagnostic laboratory that is performing the test.


Coding: Modifier 90-definition

Modifier 90 is used when laboratory procedures are performed by a party other than the treating or reporting physician or other qualified healthcare professional. The procedure may be identified by adding Modifier 90 to the usual procedure number.

To read the complete reimbursement policy, please click here.


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My name is Kate Patskovska, CPB. I am an Independent Medical Biller CPB (AAPC) and an owner of KR2 Medical Billing. KR2 Medical Billing is a full service Consulting/Medical Billing Business that is dedicated to educating, consulting, and overall improving the "financial health" of your medical practice.

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