The only collection fees that are covered are blood collection fees. All other specimen collections (throat cultures, Pap smears, etc.) are included in the office visit.

PMD covers a venipuncture fee for drawing blood (CPT code 36415). A physician can only file this when laboratory services are sent to an independent laboratory. Modifier 90 should be used with the venipunture code to indicate that the blood was drawn in the office but sent to an outside laboratory for processing. Collection of any other type of specimen is not covered as a separate billable service. Collection of throat cultures, Pap smears, etc. is considered part of the office visit. It is not appropriate to upcode an office visit due to the collection of a specimen. In order to bill a greater level office visit code there must be documentation that more was done to warrant the greater level of service.

Use CPT code 36415 with modifier 90 and type service 2 to bill a venipuncture for drawing blood when laboratory services are sent to an independent laboratory. CPT code 36416 (collection of capillary blood specimen [i.e., finger, heel or ear stick]) is covered when rendered in the physician’s office for blood work. Do not use CPT code 36415 for capillary sticks.