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Beginning January 1, 2017, QualChoice will no longer reimburse providers who bill for send out lab using modifier 90, per CMS guidelines. Charges will be denied and members cannot be billed.

Please begin working with laboratory vendors now to insure they will bill QualChoice directly for all laboratory services. CPT code 36415 (blood draws) will only be reimbursed when the lab testing is sent out. If a complete blood count is performed in house, QualChoice will not reimburse the blood draw fee.

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