2016 Outpatient Laboratory Status Indicator and Billing Changes

January 2016

Effective January 1, 2016, WSI adopted the new conditional packaging rules implemented by CMS for 2016. 

WSI reassigned laboratory services previously packaged with a status indicator “N” to a newly developed status indicator “O10”. The pre-existing “N” status indicator and new “O10” status indicator are included in the excerpt below from WSI’s 2016 Outpatient Hospital Fee Schedule Guideline:

Indicator Description Pricing Methodology
N Bundled Code Payment is bundled into the payment for other services.
O10 Laboratory services packaged when billed with another service that has a J, S, or T status indicator Pricing is determined under the WSI Clinical Laboratory Fee Schedule. When paid at U&C under that fee schedule, WSI uses the U&C rate

WSI’s “O10” status indicator is equivalent to the new CMS “Q4” status indicator. It allows most outpatient laboratory charges to pay separately when there are no other services billed with J, S, or T status indicators.

Effective for dates of service beginning January 1, 2016, WSI reimburses outpatient laboratory codes assigned a “O10” Status Indicator separately under the following circumstances:

  • A hospital receives a specimen only and the patient does not present to the hospital.
  • A patient presents to the hospital; however, lab tests are the only services provided during the encounter.
  • Lab tests are unrelated to the reason the patient has presented to the hospital, and a physician other than the physician providing the services for which the patient presented to the hospital for orders the labs. Use of the L1 modifier is required under this circumstance in order to receive separate reimbursement.

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