U.S.-based lab billing experts ensuring accurate CPT 80000–89398 coding, correct modifier application, and 97% clean claim rate for reference, molecular, and hospital labs nationwide.
Request a Free RCM AuditExpert application of chemistry, hematology, microbiology, molecular, and genetic test codes—including panel bundling rules and proprietary test validation.
Accurate use of -QW (CLIA-waived), -TC (technical component), -26 (professional), -91 (repeat test), and payer-specific modifiers to prevent automatic denials.
Pre-submission scrubbing catches missing modifiers, incorrect units, or NCCI edits—preventing 90% of avoidable lab claim rejections.
Auto-capture CPT, units, and patient data from LIS (e.g., Sunquest, Orchard) or hospital EHRs—no manual entry or test omissions.
Denied claims are appealed within 72 hours with test requisitions and clinical justification—recovering 87% of lost lab revenue.
Your U.S.-based expert tracks test-specific KPIs: reimbursement per CPT, denial trends, and payer contracts for molecular, toxicology, and genetic panels.
Laboratory billing is highly technical—missing modifiers, incorrect units, or unbundling errors trigger 100% denials or severe underpayment.
Failure to apply -QW for CLIA-waived tests or -91 for repeats leads to automatic denials under Medicare and commercial payer rules.
Submitting 1 unit for a panel that includes 12 analytes (e.g., CMP = 1 unit, not 14) triggers underpayment or bundling edits.
Commercial payers (e.g., United, Aetna) bundle lipid panels, thyroid panels, and molecular tests—missing these edits causes irreversible denials.
Missing ICD-10, ordering physician, or NPI on requisitions results in claims being rejected as non-billable.
Built for reference labs, hospital labs, and molecular diagnostics providers who demand precision in every claim.
Verify ICD-10, ordering provider NPI, patient eligibility, and prior auth (for genetic/molecular tests) before processing.
Extract CPT, units, and test details directly from your lab information system or hospital EHR.
Apply correct CPT, units, and modifiers (-QW, -91, -TC, etc.) based on test type, CLIA status, and payer policy.
Submit scrubbed claims daily with real-time NCCI and payer-specific panel bundling checks.
Monthly dashboard: avg. reimbursement per CPT, top denials, payer performance, and molecular test ROI analysis.
Clean Claim Rate
Fewer Denials
Higher Net Collections
Based on 41 lab clients served in 2024. Results may vary.
Explore our latest insights on medical billing, compliance, and specialty-specific strategies for labs and clinics.
Read Our Billing InsightsThe average lab loses $40K–$150K/year to missing modifiers, incorrect units, and unbundled panels.