Whether it was an inpatient, outpatient or professional office, or diagnostic lab claim must be known. The pricing and use of bundled codes and/or rolled-up charges depend upon the type of claim.
It’s an out patient lab test. I live in the Philippines and providers here bill on a global billing basis. Most lab test are billed as the normal name of the test since the local providers do not bill by CPT codes, (in fact they don’t know what a CPT code is, thus Tricare is forcing retirees to determine the codes and pricing for our claims or else we don’t get paid).
An example is that a urine culture test is billed in the states using three separate CPT codes for the three separate test done. Unless we identify the three normal co-procedures performed and normally billed for that test, we only get reimbursed for one CPT code, which is about 25% of the actual cost.