Date: February 14, 2019
To: Enrolled Hospitals: Chief Executive Officers; Chief Financial Officers; and Patient Accounts Managers
Re: Reminder Regarding Hospital Use of Modifier 90 for Reference (Outside) Laboratory Services
This notice serves as a reminder to hospitals regarding the use of modifier 90 to identify outpatient lab services performed at a reference (outside) laboratory. The billing requirement for modifier 90 applies to claims submitted for patients in a HealthChoice Illinois managed care organization, as well as traditional fee-for-service Medicaid.
The Department previously released notices dated February 13, 2018 and May 7, 2018 on this topic. Effective with dates of service beginning June 1, 2018, the Department requires hospitals billing outpatient non-Ambulatory Procedures Listing lab services on the 837P or HFS 2360 claim formats to use modifier 90 to identify the use of a reference (outside) laboratory.
A Department review of laboratory services billed by hospitals in the outpatient setting identified that hospitals are not consistently following the new billing policy. Hospitals must bill laboratory services with modifier TC (technical component) when performed in the hospital outpatient setting or with modifier 90 when an outside reference laboratory is used.
Hospitals should prepare adjustments to void any paid claims that were incorrectly billed and resubmit appropriately. Claim adjustment information and self-disclosure protocol is located in the All Providers Handbook Supplement on the Department’s website.
Questions regarding this notice may be directed to the Bureau of Professional and Ancillary Services at 877-782-5565.
Interim Medicaid Director