Claims Information and Claims Forms and Formats

40.1.1 - Claims Information and Claims Forms and Formats (Rev. 85, 02-06-04) Claims for referred laboratory services may be made only by suppliers having specialty code 69, i.e., independent clinical laboratories. Claims for referred laboratory services made by other entities will be returned as unprocessable. Independent laboratories shall use modifier 90 to identify all referred laboratory services. A claim for a referred laboratory service that does not contain the modifier 90 is returned as unprocessable if the claim can otherwise be identified as being for a referred service. The name, address, and CLIA number of both the referring laboratory and the reference laboratory shall be reported on the claim.