Modifier 91 is used to report any repeat clinical diagnostic laboratory test being billed if:
A single service (same CPT code) is ordered (for the same beneficiary).
Specimen is collected more than once in a single day.
The service is medically necessary.
To identify a subsequent medically necessary laboratory test on the same day of the same previous laboratory test.
When there are testing problems with the specimen.
A more appropriate procedure code is available to describe a series test.
Rerun of a laboratory test is done to confirm results.
Testing problems with the equipment.
Procedure code describes a series or panels of test.
Bill all services performed same day on the same claim.
Report each service on a separate line, with quantity of one and append 91 to the repeat procedure.
Documentation must support the use of the modifier.
A patient had multiple blood tests performed to check his potassium level after potassium replacement and low-dose insulin therapy. After the initial potassium value was measured, a subsequent blood test was ordered and performed on the same date of service.
Lab services examples:
Line 1 = 84132
Line 2 = 84132 91
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