Billing Reminders

Insurance Changes: Please provide accurate insurance that is provided at the time of the patient’s visit.  Many patients change insurance plans at the beginning of the year or mid-year, and we need this updated information in order to bill correctly for services. This includes the correct subscriber (person who carries the insurance), their DOB, and the correct policy (member number or identification number) and group numbers. 

Diagnosis Codes: Correct diagnosis codes are a necessity. Please ensure diagnosis codes are provided on every order as this is required to bill insurance. Additionally, diagnosis codes must meet medical necessity. If the diagnosis code does not meet medical necessity, then a signed ABN must be submitted with the order. There are several online resources available in order to determine whether a code is covered by insurance. Most private insurance companies follow Medicare guidelines; however, you should consult their coverage policies prior to submission: 

o Medicare Local Coverage Determinations 
o Medicare National Coverage Determination 
o PhysLab Medical Necessity Validation 
o Blue Cross Blue Shield of Nebraska Policies and Procedures 
o United Healthcare Policies and Procedures 

Correct provider: In order to bill insurance, a provider must be indicated on the order. If the patient has Medicare, a PECOS enrolled physician must order the tests. Refer to the following website to determine whether a provider is Medicare approved:[1]supplier-enrollment/order-and-referring

Select the appropriate billing directives on the order.

o Client Bill – Charges are billed back to your facility.

o Insurance Bill – Charges are billed to the patient’s insurance.

o Patient Bill – Charges are billed directly to the patient (not to insurance).

When the billing information on the order is missing, inaccurate, or the diagnosis provided does not meet medical necessity, the billing team will fax requests to your office weekly. This information is needed to submit the claim to insurance in a timely manner. Please make sure these requests are faxed back with the correct information within one week.

Supply Update

Physicians Laboratory is required to abide by all federal and state laws and regulations. In order to ensure compliance, the following information is provided for review.

The Medicare and Medicaid anti-kickback law prohibits the knowing and willful solicitation, offer, payment, or receipt of any remuneration, whether direct or indirect, in cash or in kind, to induce or in return for referrals for items or service covered by the Medicare, Medicaid, or other government health program. Violations are punishable by civil monetary penalties, criminal penalties, and exclusion from the Medicare and Medicaid programs.

The Stark regulations provide a provision that allows the laboratory to provide low-cost supplies used solely to collect specimens for the laboratory.

It is a violation of law to request supplies for the collection of specimens that are not sent to Physicians Laboratory for testing.  This includes supplies that will be sent to other laboratories and/or utilized at the client facility for in-house testing.

Additionally, due to supply chain issues, laboratory and phlebotomy materials are extremely difficult to obtain.  Please only order the minimum amount necessary and be cognizant of expiration dates on supplies at your facility.  If you are no longer using an item or they are getting near their expiration date, please send these supplies back to our facility.

In order to streamline our order fulfillment process and ensure that clients receive the supplies requested in a timely manner, orders will only be accepted via our online ordering system or by calling our customer service department.  Effective April 1st, we will no longer accept orders received by courier, fax, or mail.

To order online, please follow these instructions:

  • Go to our website at
  • Click on the Providers button
  • On the right-hand side of the screen click on the Order Supplies Button
  • Complete the information on the form including account name and number

To place a phone order, please contact our customer service department at 1(800)642-1117.  They will need the name of your facility and your account number to place the order.


Effective immediately, Chlamydia, Gonorrhea, and Trichomonas must be ordered on the original requisition. Testing can no longer be added after the Pap smear has been performed on the vial. If a patient needs to be re-collected, these tests can also be performed using a urine sample (see test #2182 and #2000).



Due to this change in policy, the following tests will require preauthorization:

Test # Test Name CPT Code
7671 Actinomyces europeaus by Real-Time PCR 87798
7526 Adenovirus by PCR 87798
8355 Aerobic Vaginitis Panel by Real-Time by PCR 87798x2, 87640, 87653
678 Affirm 87480, 87510, 87660
7633 Aptopobium vaginae by PCR 87798
7670 Bacterial Vaginosis Panel by Real-Time PCR 87798x3, 87511
7682 Bacterial Vaginosis Panel w/ M. mulieris & M. curtisii by PCR 87798x4, 87511
7646 Bacteroides fragilis by Real-Time PCR 87798
7662 BK Virus by RT-PCR Quantitative 87799
8201 Bordetella Pertussis & Parapertussis by Real-Time by PCR 87798x2
8136 BVAB2 by PCR 87798
7635 Candida albicans by PCR 87481
7636 Candida glabrata by PCR 87481
7637 Candida parapsilosis by PCR 87481
7638 Candida tropicalis by PCR 87481
7639 Candida Vaginitis Panel by Real-Time PCR 87481x4
2000 Chlamydia/GC/Trichomonas Panel by PCR 87491, 87591, 87661
675 E Coli by PCR 87798
8302 EBV by PCR, Quantitative 87799
8446 Enteric Pathogen Panel 87506
7034 Epstein Barr Virus by PCR 87798
7640 Gardnerella vaginalis by PCR 87511
7674 Genital Ulcer Disease Panel 87798x2, 87529x2
7524 H1N1 Influenza 87798
8337 Herpesvirus 8 DNA, Quant by RT-PCR 87799
7641 Leukorrhea Panel by Real-Time PCR 87661, 87491, 87591
8135 Megasphaera Species (Type 1 & 2) by PCR 87798
7645 Mobiluncus mulieris & M curtisii by PCR 87798
9384 MTB Complex Detection & Rifampin Resistance by PCR 87556, 87798
2431 Mumps by PCR 87798
7629 Mycoplasma Panel by PCR 87798x2
9339 Norovirus by PCR 87798
7723 Parvovirus B19 by PCR 87798
1427 Respiratory Viral Panel by PCR 0099U
2442 Respiratory Viral Panel by PCR (MDL) 87798x9, 87498, 87634x2
324 Rotavirus by PCR 87798
7642 Trichomonas vaginalis by PCR 87661
1987 Trichomonas vaginalis DNA 87661
7644 Ureaplasma urealyticum PCR 87798
2405 Varicella-Zoster by PCR 87798