UnitedHealthcare Laboratory Services Policy Revision

March 2018 ~

UnitedHealthcare (UHC) has made changes to its reimbursement policy for Laboratory Services affecting reference laboratories and non-reference laboratory physicians.

UHC’s Laboratory Services Policy describes reimbursement rules for duplicate laboratory services by the same or multiple physicians or other health care professionals.

The insurer’s current policy which allows for either the referring physician/other health care professional or the reference laboratory to report laboratory services, but will soon change to align with CMS guidelines that only allow reimbursement of laboratory services to the reference laboratory for referred laboratory services.

Effective for dates of service on or after June 1, 2018, only reference laboratories reporting laboratory services appended with modifier 90 will be eligible for reimbursement.

Non-reference laboratory physicians or other health care professionals that report laboratory services with modifier 90 will no longer be reimbursed.

Reference laboratories may refer to another laboratory and will continue to be reimbursed when the reported laboratory services are appended with modifier 90. Physicians or other health care professionals who own lab equipment and perform laboratory testing will continue to be reimbursed, as modifier 90 would not be appended to the procedure code for the laboratory service.

Source(s): UnitedHealthcare Network Bulletin;