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Laboratory billing services · Pathology · Toxicology · Molecular
PhysiAssist runs billing for clinical, pathology, toxicology and molecular labs: requisitions checked for medical necessity, CPT, HCPCS and PLA coding with the right units, claims, denials and AR. High-volume, low-dollar claims are worked with the same care as the large ones.
Drug testing code finder
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Units
CPT and HCPCS drug testing codes; payer policies vary
The basics
Laboratory billing services manage the revenue cycle of a clinical, pathology, toxicology or molecular lab: checking requisitions and diagnoses, coding tests with CPT, HCPCS and PLA codes, billing payers and patients, and working denials. In lab billing, missing diagnoses, units and medical necessity cause most denials.
Orders, diagnoses and ABNs checked before the claim goes out.
Presumptive and definitive testing billed to each payer's codes.
Specimens, levels, stains and professional and technical splits.
PLA codes, MolDX registration and payer coverage rules.
What we check
| Codes | What they cover | What we check |
|---|---|---|
| 80305 · 80306 · 80307 | Presumptive drug screens by method | Once per date of service, QW where required |
| G0480–G0483 · 80320–80377 | Definitive drug testing, Medicare and CPT | Drug classes documented as medically necessary |
| 87798 · 87631–87633 | Nucleic acid detection, respiratory pathogen panels | Per target or panel size, with diagnosis |
| 88305 · 88342 | Surgical pathology level IV, immunohistochemistry | Specimen count, stains, 26 and TC split |
| 81479 · PLA codes | Unlisted molecular pathology, proprietary lab analyses | MolDX registration and identifiers where required |
| 80053 · 85025 · 36415 | Metabolic panel, CBC, venipuncture | Panel rules and collection billed correctly |
| ICD-10 · ABN · GA | Diagnosis, advance beneficiary notice | Medical necessity met or patient notified |
Free laboratory billing audit
Send us a recent month of lab claims. A certified coder checks coding, units and medical necessity and sends a written report you keep, whether or not you work with us.
Claims reviewed
2,400With an issue
210Dollar impact
$21,300What the report covers
Clinical, pathology, toxicology, molecular
Labs send thousands of small claims. We automate the routine ones and put certified coders on the denials, so no test is written off because it was not worth chasing.
The systems we work in every day
We log in to your system; nothing about it changes for your team.
Claims, rejections and remittances worked through your clearinghouse.
Submissions, status checks and renewals in each payer's own portal.
Pricing
One rate of 2.8% to 5% of net collections, quoted in writing before you sign. Where you land depends on monthly collections, specialty mix, the scope of services, and your AR backlog and payer mix.
The rate covers medical coding, claim submission, payment posting, denials and AR follow-up. Front desk services, prior authorization, the reporting dashboard, patient statements, credentialing and digital marketing are quoted separately.
See full pricing and estimate your rate →Requisition and order review, eligibility, CPT, HCPCS and PLA coding, medical necessity and ABN checks, claims to Medicare, Medicaid and commercial plans, payment posting, denials and appeals, AR follow-up and patient billing.
Independent clinical labs, physician office labs, toxicology labs, pathology groups, and molecular and genetic testing labs.
Presumptive screens use 80305, 80306 or 80307 by method, once per date of service. Definitive testing uses G0480 to G0483 for Medicare by the number of drug classes, and CPT 80320 to 80377 for many commercial plans.
CPT 87798 is infectious agent detection by nucleic acid, amplified probe technique, for an organism without a more specific code. It is billed per organism, with documentation of each target tested.
Surgical pathology is billed by specimen and level, such as 88305, with add-ons for special stains and immunohistochemistry like 88342, and professional and technical components split when the slide is read by a different entity.
MolDX is a Medicare program that sets coverage for molecular diagnostic tests in several jurisdictions. Labs in those areas must register tests and report an identifier with claims. We manage the requirements and the PLA and CPT coding.
PhysiAssist charges 2.8% to 5% of net collections for coding, claims, payment posting, denials and AR, quoted in writing before you sign.
We review recent lab claims and send a written report: CPT and HCPCS coding, units, medical necessity and diagnosis support, ABNs, drug testing and molecular rules, denials by root cause and the dollar value of each.
A free laboratory billing audit by a certified coder, with a written report you keep.