Medicare Update for New Laboratory Billing Modifier L1

Posted by Kathy Dean on 05/21/2014

http://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/Downloads/MM8764.pdf

The new Laboratory billing modifier is “L1”.   So if the hospital determines that the Laboratory test is in a hospital patient scenario that should be paid then bill it on bill type 131 and put L1 on the Lab CPT codes that are to be paid.

CMS has instructed the MAC to modify the logic for packaged laboratory services. If packaged laboratory services are submitted on a bill type 131 with modifier L1, change the Status Indicator (SI) from N to A.

 Here are the scenario’s for bill type 141 and 131 along with modifier L1:

 1. Bill type 141 - non-patient laboratory specimen tests; non-patient continues to be defined as a beneficiary that is neither an inpatient nor an outpatient of a hospital, but that has a specimen that is submitted for analysis to a hospital and the beneficiary is not physically present at the hospital;

2. Bill type 131 and modifier L1 - when the hospital only provides laboratory tests to the patient (directly or under arrangement) and the patient does not also receive other hospital outpatient services during that same encounter

3. Bill type 131 and modifier L1 - when the hospital provides a laboratory test (directly or under arrangement) during the same encounter as other hospital outpatient services that is clinically unrelated to the other hospital  outpatient services, and the laboratory test is ordered by a different practitioner than the practitioner who ordered the other hospital outpatient services provided in the hospital outpatient setting.

Implementation date: July 1, 2014 -  Effective date: January 1, 2014