Directory of Services - Hitachi Chemical Diagnostics

More documents

Recommendations

Info

Allos Reference LaboratoryDIRECTORY OF LABORATORY SERVICESBILLINGAllos Reference Laboratory provides credit to all referring physicians,hospitals and reference laboratories. Monthly, summarized invoicestatements are sent to all customers with outstanding balances. AllosReference Laboratory accepts Visa ® and MasterCard ® for payment oflaboratory services.Direct Client Billing• Fill in the patient’s name, complete address, date of birth, date of seracollection, telephone number and ICD-9 Code in the space provided.• Payment is due upon receipt of Invoice Statement.• Refer to the “Patient Fee Schedule” for pricing.Please note: California State Law prohibits the offering of professionalcourtesy testing.Patient Pre-pay• Fill in the patient’s name, complete address, date of birth, date of seracollection, and telephone number in the space provided.• Payment can be made in one of two ways: 1) In the form of acheck/money order payable to “Allos Reference Laboratory,” or 2) viaVisa or MasterCard. Payment must be included with the specimen.Failure to include payment will delay testing.• Refer to the “Patient Fee Schedule” for pricing.Insurance/Third Party Billing• Fill in the patient’s name, complete address, date of birth, date of seracollection, telephone number and ICD-9 code in the space provided.• Attach a copy of the patient’s insurance card(s) to requisition form.• Include your Physician UPIN number and Physician signature on therequest form.• Refer to the “Patient Fee Schedule” for pricing.3
Allos Reference LaboratoryDIRECTORY OF LABORATORY SERVICESCPT CODINGThe following CPT Codes have been identified courtesy of the 2011 AMACPT Code Book. Allos Reference Laboratory is happy to provide thisinformation, but cannot be liable for any misfiled claims.DescriptionCPT CodeCollection of venous blood by venipuncture 36415Handling and/or conveyance of specimen fortransfer from the physician’s office to alaboratoryAllergen Specific IgE; Quantitative orSemiquantitative, Each Allergen20 Allergen Panel x 2025 Allergen Panel x 2536 Allergen Panel x 3699000860034
Page 2: TABLE OF CONTENTSServices..........
Page 7 and 8: ALLOSReference LaboratoryReference
Page 9 and 10: Allos Reference LaboratoryDIRECTORY
Page 21: Allos Reference LaboratoryDIRECTORY

Directory of Services - Hitachi Chemical Diagnostics

You also want an ePaper? Increase the reach of your titles

Delete template?

Save as template?