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August 2015

Here’s how to report charges for CPT II codes for lab services performed in office setting

When a physician performs laboratory tests *80061, *83036 or *83721 in the office, they are required to report the corresponding CPT II code (*3044F, *3045F, *3046F, *3048F, *3049F or *3050F). (Refer to the September 2013 Record article for more information.)

Providers should report a penny ($0.01) on the *3044F, *3045F, *3046F, *3048F, *3049F and *3050F claim lines as the charge billed. Providers will not receive reimbursement of the penny, as these codes are only for documentation purposes. Blue Cross Blue Shield of Michigan began paying health care providers an additional $5 per billing for LDL-C and HbA1c screeninglab services, as of July 15, 2013, and it’s included in the reimbursed fee.

This reporting information is for services performed in a physician office setting for members with PPO, Traditional and Medicare Advantage PPO plans when billed with the correct CPT Category II codes. These CPT Category II codes represent results of the tests in the form of a range of values.

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*CPT codes, descriptions and two-digit numeric modifiers only are copyright 2014 American Medical Association. All rights reserved.
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