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Insurance AR recovery
Insurance AR recovery across Medicare, Medicaid, and 1,000+ payers. See also: AR recovery services.
Laboratory billing services
Laboratory billing services
Laboratory billing runs on volume: hundreds or thousands of claims per week, most of them low-dollar, each requiring lab-specific CPT, HCPCS, or PLA coding that general billers do not handle. At lab margins, a single coding error on a routine panel costs pennies to make and weeks to fix.
1,000+ Payers | 48hr Denial Turnaround | PAMA + CLIA + HIPAA Compliant
1,000+ Payers
48hr Denial Turnaround
PAMA Compliant
CLIA + HIPAA Compliant
Why laboratory billing breaks differently
Why laboratory billing breaks differently
Physician billing
Physician practices process 20 to 60 claims per day at $150 to $500 each. A denied claim justifies the $25 to $57 in rework cost.
Laboratory billing
Labs process hundreds of claims daily at $10 to $50 each. A denied $15 CBC panel is not worth reworking, so it gets written off. Multiply that across a month and the leak is material.
The coding is structurally different too. Labs work with CPT codes (80047 through 89398), HCPCS, and Proprietary Laboratory Analyses (PLA) codes that update quarterly through the AMA. The AMA estimates that more than 50% of laboratory claims ship with incorrect codes. Factor in CLIA tier requirements, payer-specific medical necessity rules, Medically Unlikely Edit (MUE) caps, and the technical-versus-professional component split, and general billing expertise falls short.
PAMA: $4 billion in cuts and counting
PAMA: $4 billion in cuts and counting
Since 2018, PAMA has reduced Medicare lab payments by over $4 billion according to ASCP and NILA. Common tests like CBC, basic metabolic panel, and lipid panels have seen cumulative reductions of 30% or more. The Consolidated Appropriations Act of 2026 delayed the next round of 15% annual cuts through December 31, 2026, but reductions resume in 2027 based on private payer data labs are reporting to CMS during the May 1 through July 31, 2026, window.
We help labs navigate PAMA data reporting: identifying whether your lab meets the applicable laboratory threshold, collecting the required HCPCS codes, private payer rates, and test volumes, and submitting within the CMS deadline.
What we cover
What our diagnostic billing services cover
We are a lab billing company built for that reality. Our laboratory billing services cover the full revenue cycle for clinical labs, hospital outreach, reference labs, molecular diagnostics, toxicology, and pathology practices. Coding, claim submission, denial management, PAMA compliance, and CLFS reporting, handled by a team that does lab billing exclusively.
Coding is where most lab revenue is won or lost. Clinical laboratory billing requires tracking quarterly PLA code updates, monitoring LCD and NCD changes for medical necessity determinations, and verifying MolDX Z-code registration for molecular assays where required by Medicare Administrative Contractors and commercial payers like UnitedHealthcare and Humana. When a test does not have an established code, we identify the correct unlisted code and documentation path.
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CPT, HCPCS & PLA coding
Lab-specific CPT codes (80047–89398), HCPCS Level II, and quarterly PLA code updates applied by coders who work lab claims exclusively.
03
PAMA & CLFS reporting
We identify whether your lab meets the applicable laboratory threshold, collect required data, and submit within the CMS window.
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Denial management
Root-cause analysis and resubmission within 48 hours. Denial patterns tracked across your full claim volume to prevent recurrence.
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MolDX Z-code registration
Z-code registration through the MolDX program for molecular assays and prior authorization management for genetic panels.
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Coverage & credentialing
Payer enrollment and re-credentialing kept current. See: credentialing services and coverage discovery.
Built for every type of laboratory
Built for every type of laboratory
Clinical and reference labs
High volumes across routine panels (CBC, BMP, CMP, lipids). We manage each claim individually, not in batches, so coding and eligibility errors are caught before submission.
Hospital outreach labs
The 72-hour rule bundles outpatient lab services performed within 72 hours of an inpatient admission. We flag these before submission to prevent bundling denials and coordinate between hospital and lab billing departments where most outreach revenue leaks occur.
Molecular diagnostics and genetic testing
PLA codes for proprietary tests issue quarterly, and many advanced molecular tests require manual rate negotiation with payers who have no established fee schedule. We manage Z-code registration through the MolDX program and handle prior authorization for genetic panels to prevent post-service denials.
Toxicology labs
Payer scrutiny around medical necessity is intense, especially for confirmatory testing beyond the initial presumptive screen. We verify that each claim stays within Medically Unlikely Edit (MUE) unit caps and documents the clinical rationale tying the test to the appropriate diagnosis.
Pathology billing
Pathology uses dual coding: anatomic (CPT 88000 through 88399) and clinical (80047 through 85999). Surgical pathology levels (88300 through 88309), immunohistochemistry (88342 through 88346), and cytopathology (88104 through 88199) each require complexity-based coding. We manage the technical component (TC) and professional component (modifier 26) split on every interpretation, one of the most common sources of immediate denials in pathology.
Works with your existing lab systems
Works with your existing lab systems
You keep your LIS and EHR. We work inside your existing setup with integrations scoped during the free revenue assessment. See also: medical coding services.
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Your lab runs the tests. We collect the revenue.
The free revenue assessment covers your denial rate by root cause, coding accuracy against current CPT and PLA code sets, PAMA reporting status, and estimated recoverable revenue. You keep the findings whether or not you work with us.
Laboratory billing questions we get asked
Laboratory billing questions we get asked
Direct answers for labs, pathology practices, and diagnostic centers evaluating a billing partner.
What makes laboratory billing different from physician billing?
Labs process high volumes of low-dollar claims where the cost of reworking a denial often exceeds the claim value. Lab coding involves CPT, HCPCS, and PLA codes that update quarterly, payer-specific medical necessity rules, CLIA tier requirements, MUE unit caps, and technical-versus-professional component splits that physician billing does not deal with.
What is PAMA and how does it affect my lab?
PAMA is the Protecting Access to Medicare Act. It restructured Medicare lab payments based on private payer rate data. Since 2018, PAMA has cut over $4 billion in Medicare lab payments. The next round of 15% annual reductions begins in 2027 based on data labs are reporting to CMS during the May through July 2026 window.
What types of laboratories do you work with?
Independent clinical labs, hospital outreach programs, reference labs, molecular diagnostics and genetic testing labs, toxicology labs, and pathology practices. Each lab type has distinct coding, compliance, payer, and regulatory requirements that we manage as part of the billing engagement, not as a generic add-on.
How do you handle pathology billing specifically?
Pathology billing uses dual coding systems: anatomic pathology (CPT 88000 through 88399) and clinical pathology (80047 through 85999). We code surgical pathology levels, immunohistochemistry, and cytopathology by complexity, and manage the technical component (TC) and professional component (modifier 26) split on every interpretation to prevent modifier-related denials.
How do you handle lab claim denials?
We analyze each denial by root cause, whether that is a coding error, missing modifier, eligibility gap, or medical necessity rejection. We correct the issue and resubmit or appeal within 48 hours. We also track denial patterns across your claim volume to fix recurring problems at the workflow level, not one claim at a time.
Do you handle PAMA data reporting?
Yes. We help labs determine whether they meet the applicable laboratory threshold, collect the required HCPCS codes, private payer rates, and test volumes, and submit within the CMS reporting window. The current period runs May 1 through July 31, 2026, using data collected from January through June 2025.
What coding systems do you use for laboratory and diagnostic billing?
CPT codes for standard lab and diagnostic tests, HCPCS for supplies and certain services, and PLA codes for proprietary tests. PLA codes update quarterly through the AMA. For molecular assays, we also manage MolDX Z-code registration where required by Medicare Administrative Contractors and commercial payers.
How do I get started?
Request a free revenue assessment. We review your current denial rate, coding accuracy, payer mix, and PAMA exposure, then deliver a written report with your findings, estimated recoverable revenue, and specific recommendations for your lab type. No obligation, no upfront cost, and you keep the report whether or not you work with us.
Ready when you are
Your lab runs the tests. We collect the revenue.
The free revenue assessment covers your denial rate by root cause, coding accuracy against current CPT and PLA code sets, PAMA reporting status, and estimated recoverable revenue. You keep the findings whether or not you work with us.
- Denial rate by root cause across your claim volume
- Coding accuracy against current CPT and PLA code sets
- PAMA reporting status and filing window exposure
- Estimated recoverable revenue
- HIPAA-compliant — BAA signed before data moves
- No setup fee. No long-term contract.