MedicaidBilling CodesHigh impact
Chapter L-200, Handbook for Providers of Laboratory Services Correction Regarding Global Laboratory Billing in the Hospital Outpatient Setting and Hospital Use of Modifier “90” for Reference Laboratory Services
Illinois Medicaid - HFS·IL · Pathology·Provider Notice
Effective date
Jul 20, 2018
We identified it
Jun 20, 2026
Summary
Hospitals can no longer bill global laboratory services in the outpatient setting. The professional component must be billed under the pathologist's name and NPI, regardless of whether the pathologist is salaried by the hospital. Hospitals may only bill global services for reference laboratory tests using modifier '90'.
Action Required
Immediately: Hospital billing teams must separate laboratory billing into technical and professional components for outpatient services. Bill technical component under hospital NPI, professional component under pathologist's individual NPI even if salaried. Use modifier '90' when billing global services for reference laboratory tests only. Update billing system rules to prevent global laboratory billing except for reference labs.