Avoid Billing Issues – Laboratory Services

Last modified: July 17, 2020

For you to be paid in a timely manner, we require an accurate place of service (POS) code on claims for your patients who are UnitedHealthcare benefit plan members. To assist you with improved payment accuracy, and help your practice avoid delays in claims payments, we would like to make you aware that resources/options are available.

Here’s what you need to know

UnitedHealthcare has identified an increase of claims where billing laboratory services for inpatients of a hospital have had the incorrect place of service.

  1. UnitedHealthcare uses the codes indicated in the Centers for Medicare and Medicaid Services (CMS) Place of Service Codes for Professional Claims Database to determine if laboratory services are reimbursable.
  2. The POS designation identifies the location where the laboratory service was provided, except in the case of an Independent or a Reference Laboratory.
    • An Independent or Reference Laboratory must show the place where the sample was taken (if drawn in an Independent Lab or a Reference Lab, POS 81 is reported; if drawn in a hospital inpatient setting, the appropriate inpatient POS is reported). If an independent laboratory bills for a test or sample drawn on an inpatient of a hospital, the laboratory must report the code for the inpatient (POS code 21).
  3. Lines containing CPT codes for laboratory services billed while members are inpatient of a hospital without the appropriate POS appended may result in a line denial, and you should not balance bill members for those services.

Questions?  Please email us at education.info@optum.com and we’ll respond within two business days.