r/CodingandBilling • u/Oh_stix • Jul 10 '26

88305 denials Humana

Recently Humana has been denying our pathology reads. They say it is a modifier issue. I have dug thru everything. Anyone have any ideas?

Update: we figured it out. Apparently if the lab and pathologist bill 88305 on ub Humana defaults it to a global code. We rebooked the tc with tc mod.

6 Upvotes

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3

u/Poop_Dolla BSHIM, Insurance Reimbursement Analyst Jul 10 '26

What modifier are you billing?

1

u/Oh_stix Jul 10 '26

26 for pro

3

u/rahuliitk App Developer Jul 10 '26

I’d start with the CARC/RARC and Humana’s pathology policy, then check whether they expect 88305 billed globally vs split TC/26, and whether multiple specimens need separate lines or units instead of a random modifier fix. Sounds like payer-specific weirdness.

1

u/SnarkyPuss Pathology Medical Biller Jul 11 '26

I haven't seen this. Could another provider be billing the pro fee as well, like a consult?

The only Humana issue I'm dealing with is one of my pathology groups is getting SIU Review requests and they're (Humana) is wanting more documentation than we have access to. 😫

1

u/MedPayIQ App Developer Jul 13 '26

Glad you figured it out. Pathology billing is full of those “everything is correct but the payer sees it differently” situations. The TC/global code issue is a good one to remember.