CPT modifier
Modifier 90: Reference (outside) laboratory
Modifier 90 is a CPT modifier. In plain terms: The billing provider sent the lab test to an outside laboratory that did the test.
Run it in Rivvi
Check the codes on your claims export
Upload a claims export. Rivvi flags ICD-10 and HCPCS codes that are not billable or are replaced. It does not check modifiers.
Check my exportFree to start. Opens Rivvi, the AI workspace for healthcare teams.
- Modifier
- 90
- Type
- CPT (Level I) modifier, maintained by the AMA
- Plain description
- The billing provider sent the lab test to an outside laboratory that did the test.
- How it is used
- Medicare rules limit when a provider may bill for a test another lab performed.
- Claim form
- CMS-1500 item 24D, up to four modifiers per line. 837P SV101-3 to SV101-6.
The CPT descriptor is AMA copyright and is not shown here. The description above is written by Rivvi. Read the CMS guidance linked above for Medicare's rules.
Laboratory
Related modifiers
Related pages
- All CPT and HCPCS modifiersA to Z list
- CMS-1500 claim formModifiers go in item 24D
- Denial code CO-4Modifier missing or does not fit the code
- Denial code CO-182Modifier invalid on the date of service
- Denial code CO-B23Not allowed under the lab's CLIA certificate
- HCPCS Level II code lookup
- Denial and remark codes
Questions
What does modifier 90 mean?
Modifier 90 is a CPT modifier. In plain terms: The billing provider sent the lab test to an outside laboratory that did the test.
Is modifier 90 a CPT or a HCPCS modifier?
90 is a CPT (Level I) modifier. The AMA maintains CPT modifiers. Two-character codes with a letter, such as GT or XU, are HCPCS Level II modifiers from CMS.
Where does modifier 90 go on a claim?
On the CMS-1500 it goes in item 24D next to the procedure code. Each line holds up to four modifiers. On an 837P it goes in SV101-3 to SV101-6.
When is modifier 90 used?
Medicare rules limit when a provider may bill for a test another lab performed.
What denial comes back when a modifier is wrong?
A missing or mismatched modifier often comes back as CARC 4. A modifier that was not valid on the date of service comes back as CARC 182. A bundling edit the modifier should have bypassed comes back as CARC 97 or 236.