Laboratory Billing
Specialized coding and billing for independent and clinical labs.
About Laboratory Billing
Laboratory billing carries its own set of coding requirements, payer-specific coverage policies, and compliance rules that general medical billers often miss. Reference labs, clinical labs, and pathology groups need specialists who know the field.
Our laboratory billing team handles CPT coding for molecular, anatomic pathology, clinical chemistry, and toxicology panels — along with ABN management, PAMA compliance, and laboratory-specific denial patterns.
What's Included
- Lab-specific CPT and HCPCS coding
- Molecular diagnostic billing
- Toxicology panel billing
- Anatomic pathology coding
- PAMA pricing compliance
- ABN management
- Reflexive test billing
- Medicare LCD review
- Payer coverage determination
- NPI and CLIA number billing
How We Do It
- Review lab reports and requisitions for billable services.
- Assign CPT codes per current PAMA and LCD guidelines.
- Verify patient ABN status for tests with coverage limitations.
- Submit claims with required modifiers and NPI/CLIA identifiers.
- Follow up on denials related to medical necessity or coverage limitations.
- Report payer-specific denial trends and recommend test ordering documentation improvements.
Common Questions
Do you bill for both independent and physician-owned labs?
Yes. We bill for independent reference labs, hospital-based labs, and physician-owned lab facilities under the appropriate provider type and NPI.
How do you handle Medicare PAMA pricing?
We apply current PAMA-mandated pricing for all Medicare clinical diagnostic lab tests and monitor for annual updates.
Related Services
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