Multiple Laboratory Services

Multiple services from the Laboratory Services Outpatient Payment Schedule are usually billed at 100%; specific exceptions are listed in the Schedule. The following examples are provided to assist you in understanding how to bill multiple laboratory services.

Multiple Immunoglobulin and Specific Protein Assays

Refer to the Chemistry Section in the Laboratory Services Outpatient Payment Schedule. When more than one immunoglobulin and specific protein assay is billed additional items are paid at the same rate as fee item 91831 (Immunoglobulin and specific protein assays - additional assay, same patient, same specimen, same day) at $12.53. All assays are billed under the specific fee item for the tests performed. MSP will reduce payment to the same rate as fee item 91831.

Example: Tests performed - 91165 (Apolipoprotein A-1); 91170 (Apolipoprotein B-100; 91825 (Immunoglobulin D)
  Billed* Paid*
  91165 @ $20.40 91165 @ $20.40
  91170 @ $16.60 91170 @ $12.53
  91825 @ $20.40 91825 @ $12.53
  * Rates effective as of June 1, 2018 (subject to change).

Multiple Drug Assays

Refer to the Chemistry Section, under the Laboratory Services Outpatient Payment Schedule.

When more than one drug assay is billed from the listings under - Drug Assay (single) - applicable to fee items 91482 to 91574, the maximum amount paid will be equivalent to fee item 91599 - Drug Assay - multiple (2 or more) at $53.46.

All assays are billed under the specific listings for the tests performed. MSP will reduce payment so that the maximum amount paid for one day is equivalent to fee item 91599.

Example: Tests performed - 91484 (Amikacin); 91502 (Clozapine); 91506 (Desipramine)
  Billed* Paid*
  91484 @ $45.99 91484 @ $45.99
  91502 @ $27.92 91502 @ $7.47
  91506 @ $24.35 91506 @ $0.00
  * Rates effective as of June 1, 2018 (subject to change).

Duplicate/Multiple Laboratory Services

Some items in the Laboratory Services Outpatient Payment Schedule can be billed more than once for the same patient on the same day.

When billing multiple laboratory services, put the items on the same line, whenever possible. If billing more than the usual limit, a note record is required.

If the multiple services are performed at different times on the same day, include the time on each billing or provide a note record to indicate that specimens were taken at different times, along with the medical requirement (such as pre and post dialysis).

Example: Fee item 90720 (Routine Culture) is normally billed once per patient, per day. Fee item 90720 can be billed up to three times per patient per day, if the specimens are taken from separate sites.

Assume that there were two specimens, one from each eye.

Billing Two Services on the Same Line:

 
  Fee item Number of Services Note Record
  90720 2 Left and right eyes
 
 

Billing Two Services on Separate Lines:

When billing duplicate services on separate lines, note records must be different from each other, and submission code "D" must be used on second and subsequent tests.
 

  Fee item Number of Services Note Record Submission Code
  90720 1 left eye  
  90720 1 right eye D


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Disclaimer: MSP Tutor is intended to provide a guide for physicians and medical office assistants in billing claims to MSP. For definitive information on Laboratory fee-for-service fee item codes and amounts, consult the current Schedule of Fees For the Laboratory Services Outpatient Payment Schedule. If a discrepancy exists between the information contained in MSP Tutor and the Schedule of Fees For the Laboratory Services Outpatient Payment Schedule, the information in the Payment Schedule will prevail.