Process for pathology, laboratory, and other codes
Important billing information
When medical records are not submitted to support the code billed (for the codes linked below), the service will reject. The claim must then be resubmitted with the appropriate documentation.
Documentation submitted from the medical record to support the initial claim submission for the codes linked below may include one or more of the following:
- Orders and test results for the test performed
- History and physical examination
- Progress or office notes for the test performed
- Any additional documentation in the medical record that supports the need for the service
Codes requiring documentation
Avoid negative impacts to your claims by providing medical records with your initial claim submission for the codes linked below. Please consult these lists frequently as they may be updated quarterly.