Field 20 - Outside Lab? $Charges
“Outside lab? $Charges” indicates that services have been rendered by an independent provider as indicated in Item Number 32 and the related costs.
NUCC INSTRUCTIONS: Complete this field when billing for purchased services by entering an X in “YES.” A “YES” mark indicates that the reported service was provided by an entity other than the billing provider (for example, services subject to Medicare’s anti-markup rule). A “NO” mark or blank indicates that no purchased services are included on the claim.
If “YES” is marked, enter the purchase price under “$Charges” and complete Item Number 32. Each purchased service must be reported on a separate claim form as only one charge can be entered.
When entering the charge amount, enter the amount in the field to the left of the vertical line. Enter number right justified to the left of the vertical line. Enter 00 for cents if the amount is a whole number. Do not use dollar signs, commas, or a decimal point when reporting amounts. Negative dollar amounts are not allowed. Leave the right-hand field blank.
MEDICARE INSTRUCTIONS - Complete this item when billing for diagnostic tests subject to the anti-markup payment limitation. Enter the acquisition price under charges if the "yes" block is checked. A "yes" check indicates that an entity other than the entity billing for the service performed the diagnostic test. A "no" check indicates "no anti-markup tests are included on the claim." When "yes" is annotated, item 32 shall be completed. When billing for multiple anti-markup tests, each test shall be submitted on a separate claim form CMS-1500. Multiple anti-markup tests may be submitted on the ASC X12 837 electronic format as long as appropriate line level information is submitted when services are rendered at different service facility locations. See chapter 1.
NOTE: This is a required field when billing for diagnostic tests subject to the anti-markup payment limitation.
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