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Appropriate Use of Modifier 91

May 9, 2013

Modifier 91 is used to report repeat laboratory tests or studies performed on the same day on the same patient. This modifier is added only when additional test results are to be obtained subsequent to the initial administration or performance of the test(s) on the same day. It is not used when laboratory tests or studies are simply rerun because of specimen or equipment error or malfunction. Nor is it to be used when a test is repeated to confirm initial test results. Further, based on the definition of modifier 91, it should not be reported when the basic procedure code(s) indicate that a series of tests are to be obtained. CPT codes for use with modifier 91 are in the laboratory code range 80047-89398. Services with multiple units should be billed on one line with the appropriate units and modifier indicated.

Clear Claim Connection™ (C3) will continue to be the resource that allows disclosure of claim auditing rules and clinical rationale to the BCBSTX independently contracted provider network. C3 is a free online tool available to providers who are registered with Availity®’ or RealMed®’’.

To access Clear Claim Connection, you will need to register with one of the following web based portals: availity.com  or realmed.com .

For your reference, we also have provided the log-in instructions to register with Availity®’ or RealMed’’ below:

Once you have entered Clear Claim Connection, you have the ability to enter claims data in order to display the claims auditing results.

If you would like more information, you may contact your Provider Relations office or Provider Customer Service at 800-451-0287.

For more information about Clear Claim Connection, along with ClaimsXten Frequently Asked Questions (FAQs), visit the Education and Reference Center/Provider Tools section of our provider website at bcbstx.com/provider.

 

CPT copyright 2010 American Medical Association (AMA). All rights reserved. CPT is a registered trademark of the AMA

ClaimsXten and Clear Claim Connection are trademarks of McKesson Information Solutions, Inc.

Availity is a registered trademark of Availity, L.L.C. RealMed is a registered trademark of RealMed Corporation, an Availity Company.

McKesson Information Solutions, Inc., Availity, L.L.C. and RealMed Corporation are independent third party vendors and are solely responsible for their products and services. BCBSTX makes no representations or warranties regarding the products or services provided by either of these vendors. If you have any questions regarding the products or services provided by these vendors, you should contact the vendor(s).