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Reference Laboratories ONLY - Changes to reimbursement of 99000 and 99001 effective Sept 1, 2011



BCBSNC is modifying its billing and claims submission and reimbursement policies. Specifically, reference laboratories should not bill and submit claims, nor will BCBSNC reimburse, for CPT Codes 99000 and 99001 related to covered services rendered to our members on or after September 1, 2011.

The CPT 2011 Professional Edition defines code 99000 as handling or conveyance of specimen for transfer from the physician's office or laboratory. Additionally code 99001 is defined as handling or conveyance of specimen for transfer from the patient in other than a physician's office to a laboratory. Based on the fact that a reference laboratory is a separate entity from the provider that collects the specimen and transferring the specimen from the collecting provider to the reference laboratory is a component of the laboratory services rendered by the reference laboratory, BCBSNC has determined that these CPT Codes should not be billed by a referenced laboratory nor reimbursed.

BCBSNC's Medical Policy entitled Bundling Guidelines description of Specimen Handling and Conveyance will be updated accordingly and available at: https://www.bcbsnc.com/assets/services/public/pdfs/medicalpolicy/bundling_guidelines.pdf.

This change is applicable for all BCBSNC lines of business.

If you have any questions please contact your Provider Relations Representative.