Eligibility & Verification
Coverage checks before every visit.
Specialty Billing
Laboratory Billing Medical Billing
Lab billing means very high claim volumes and strict medical-necessity rules. We handle panel vs. individual test coding and LCD/NCD compliance so your lab claims pass the first time.
The Challenge
Laboratory Billing billing, solved
We understand the billing complexities unique to laboratory billing and build them into every claim.
- High-volume claim processing
- Panel vs. individual test coding
- Medical necessity (ABN, LCD/NCD)
What we focus on
- Lab panel coding
- Medical necessity / ABN
- Payer-specific lab rules
Coding Focus
Laboratory Billing code sets we work in
The CPT/HCPCS procedure families and ICD-10 diagnosis groups our certified coders handle for this specialty every day.
Common CPT / procedure codes
- 80047–80076Bundled metabolic and organ-based panels
- 85002–85999Hematology and coagulation studies
- 87070–87999Microbiology cultures and infectious testing
- 80305–80377Drug screening and toxicology assays
ICD-10 diagnosis focus
- Endocrine and metabolic monitoring such as diabetes and lipids (E-chapter)
- Preventive and screening encounters (Z-code family)
- Renal and genitourinary conditions (N-chapter)
- Abnormal findings without definitive diagnosis (R70–R99)
Code references are shown as general identifiers for illustration. Actual code selection always follows current payer rules and your provider's documentation.
Clean Claims
Modifiers, denials & billing rules we manage
How our team keeps laboratory billing claims compliant — the modifiers that matter, the denials we prevent, and the guidelines we follow.
Key modifiers
- 91
Reports a medically necessary repeat of the same lab test on the same day.
- 59
Distinguishes separately reportable specimens or tests bundled by edits.
- QW
Identifies a CLIA-waived test performed under the correct certificate.
- GA
Indicates an advance beneficiary notice was signed for a likely non-covered test.
Common denials & fixes
Individual analytes billed instead of the appropriate panel code.
Apply NCCI edits and panel rules so components roll up into the correct single panel code.
Test frequency exceeds the payer's covered interval.
Check frequency limits and secure documentation or an ABN before repeating limited tests.
Missing or unsupported medical necessity for the ordered test.
Confirm a covered diagnosis on the order and use an ABN when coverage is uncertain.
Invalid or absent ordering-provider NPI or diagnosis.
Validate the referring NPI and diagnosis on requisition intake before the claim is created.
Billing guidelines
- Bill panels as a unit rather than unbundling component analytes.
- Screen orders against payer frequency and medical-necessity edits before running.
- Attach the correct ordering-provider details to every requisition.
- Apply QW to waived testing and confirm the lab's CLIA level.
End-to-End
What we handle for Laboratory Billing
A complete revenue cycle service tailored to your specialty.
Specialty Coding
Certified, specialty-trained coders.
Charge Entry & Claims
Clean, accurate claim submission.
Payment Posting
ERA/EOB posting and reconciliation.
Denial & AR Management
Appeals and aggressive AR recovery.
Reporting & Analytics
Real-time KPIs and insights.
98%
Clean claim rate
30%
Average revenue lift
24/7
Operations coverage
HIPAA
Compliant processes
FAQ
Laboratory Billing billing — FAQs
Yes — our certified coders are trained on specialty-specific rules, code sets, and payer policies, and we assign coders with experience in your specialty.
We work in your current practice management system and EHR, so your workflows and reporting stay intact while we handle the billing.
Through accurate specialty coding, front-end eligibility checks, clean claim submission, and relentless denial and AR follow-up — typically lifting first-pass acceptance and net collections.
Always. We use strict access controls, encryption, signed BAAs, and audit trails to protect patient data.
More Specialties
Other specialties we bill for
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