Reimbursements

Category:

Lab Re-Bundling

Reimbursement Policy: NDRP-LP-003
Topic: Lab and Pathology
Effective Date: July 1, 2018
Last Reviewed:
February 27, 2019

Description:

This policy addresses coverage and reimbursement for laboratory re-bundled services.

Definitions:

Organ or Disease-Oriented Panels

The tests listed under each lab panel (80047-80076) identify the defined components (lab tests) of that panel.

Re-Bundling

The submission of multiple procedure codes for a group of specific procedures that are components of a single comprehensive code.

Policy:

Laboratory procedures should be submitted using the CPT or HCPCS code that best describes the service.

The tests listed under each organ or disease-oriented panel (80047- 80076) identify the defined components of that panel, and all tests listed must be performed in order to bill for that panel. Tests performed in addition to those specifically indicated for a particular panel can be billed separately in addition to the panel code.

If a panel is submitted and one of the lab procedures/tests is repeated, that single repeat component may be billed with the individual service code will require submission of modifier 91 (not 59).

Lab panels should be reported as 1 line item with 1 unit per panel.

Procedure Code Unbundling/Replacement

Procedure code unbundling is the submission of multiple procedure codes for a group of specific procedures that are components of a single comprehensive code. Procedure unbundling may occur in one of two ways:

  • A professional claim could be submitted that has procedure codes for both the individual components, and the procedure code for the comprehensive procedure. Blue Cross would re-bundle the individual component codes into the comprehensive procedure code for payment.
  • Procedure unbundling could also occur when a professional claim is submitted with only the individual components of the comprehensive code. In this situation, the software will recognize the relationship between the comprehensive code and its individual components. Then, it will automatically add the comprehensive code to the claim and re-bundle the individual components into that comprehensive code for payment.

Do not report two or more panel codes comprising the same tests; report the panel with the highest number of tests to meet the definition of the code, and report the remaining tests individually.