Laboratory Billing Services

Specialty Focus

Laboratory Billing That Captures What You've Earned

Laboratory billing is one of the most denial-prone areas in healthcare. LCD and NCD policy compliance, ABN management, reflex and add-on test coding, and CLIA compliance each create complex billing scenarios where errors cost real revenue — or worse, create compliance exposure.

Prime Medical Billing's lab billing team navigates HCPCS and CPT coding, local coverage determinations, and ABN workflows with precision. We handle reflexive test billing, panel unbundling rules, and Medicare CLIA requirements — ensuring your lab captures maximum reimbursement while staying fully compliant.

97%

First-Pass Clean Claim Rate

24h

Average Claim Submission

40%

Average A/R Reduction

HCPCS/CPT laboratory coding

ABN creation & management

LCD/NCD compliance verification

Reflexive & add-on test billing

Medicare CLIA compliance

Panel bundling & unbundling rules

Pathology coordination coding

Real-time eligibility verification

Electronic remittance posting

Monthly performance reporting

Specialty-Trained Coders

Our billers are trained in your specialty's CPT codes, ICD-10 diagnoses, and payer-specific rules — not generalists working across 50 specialties.

97%+ Clean Claim Rate

We scrub and submit clean claims the first time, reducing rework, accelerating payment, and improving your net collection rate.

24-Hour Denial Recovery

Every denied claim is reviewed within 24 hours, root cause identified, corrected, and re-submitted before payer appeal deadlines close.

Full HIPAA Compliance

Encrypted data handling, a signed Business Associate Agreement, and annual compliance audits — your patients' information is always protected.

Maximize Your Laboratory Revenue

Get a free billing audit and find out exactly how much revenue your practice could be recovering. No contracts, no obligation — just results.

Get Your Free Billing Audit Call 346-307-9057

HIPAA Compliant • No Long-Term Contracts • Results in 30 Days

Do you handle CLIA-compliant laboratory billing for independent labs?

Yes. We verify that your CLIA certificate is current and matches the tests billed, apply the correct CPT codes for ordered tests, and ensure all NPI and taxonomy information is accurate on every claim. For physician office labs (POL), we coordinate between the ordering provider and the CLIA-certified testing entity.

How do you manage Advance Beneficiary Notices (ABN) for Medicare lab billing?

When a test may not be covered by Medicare due to LCD limitations, an ABN must be issued to the patient before the test is performed. We maintain current LCD policies for your top 20 tests, flag non-covered indications during order entry, and ensure ABN documentation is on file before submitting with modifier GA.

Do you bill molecular diagnostics and genetic testing?

Molecular diagnostics (PLA codes, 81200+ series) are among the most complex and highest-value tests in laboratory billing. We stay current on CPT additions in this rapidly evolving code set, verify payer coverage policies for each test, and manage prior authorization for high-cost molecular panels.

How do you ensure Local Coverage Determination (LCD) compliance for lab claims?

Every test we bill is checked against applicable LCDs from the patient's MAC. If the ICD-10 code doesn't appear on the covered diagnoses list, we either query the ordering provider for a covered indication or prepare the claim for ABN-based billing with the appropriate modifier — preventing unrecoverable denials.

Laboratory Billing That Captures What You've Earned

Key Billing Areas for Laboratory Practices

Built for Laboratory Billing Complexity

Specialty-Trained Coders

97%+ Clean Claim Rate

24-Hour Denial Recovery

Full HIPAA Compliance

Maximize Your Laboratory Revenue

Laboratory Billing — FAQ

We Serve All Medical Specialties