What are the ethical issues surrounding professional component clinical laboratory services?

Billing private patients and private insurance companies for the professional component of clinical pathology services is clearly ethical and appropriate. The American Pathology Foundation and the College of American Pathologists recognize professional component billing. The American Medical Association, since 1993, which develops and publishes all CPT codes has clearly inform the pairs that pathologists may bill for professional components of clinical pathology services using the -26 modifier.

In December of 2004 the American Medical Association issued a letter reaffirming that "the use of the -26 modifier is appropriate to describe physician professional services associated with CPT codes 80048-8799 when the physician and only billing for the professional component of the clinical laboratory test (I.E., medical direction, supervision, or interpretation)." 7. What are the legalities involved in billing patients for the professional component of clinical laboratory services? The ... more.

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