2014 Billing Outpatient Lab Charges

This article highlights a significant change in billing of lab work provided in the outpatient hospital setting.

Following Medicare requirements, WSI reimburses for lab codes with an N Status Indicator separately under the following guidelines:

• hospital receives a specimen only and the patient does not present to the hospital
• 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 is presenting to the hospital and ordered by a physician other than the physician providing other services on the same date

In these scenarios, the hospital should bill the lab charges with bill type of 131 and modifier L1 added to the lab code to indicate the charges are not part of other procedures the patient has received

If you have questions about this article, please send an email to wsipr@nd.gov.