Laboratory billing built for independent labs that need real specialization.
Clinical, molecular, pathology, and toxicology lab billing done by coders who actually know CPT 80000-89999, LCDs, and payer-specific medical necessity rules. Twelve years, twenty-plus states, and denial appeal rates that keep your lab profitable.
The 4 places labs lose money every month.
Most billing companies handle the easy 60%. We fix the 4 danger zones where labs quietly bleed revenue.
Test Order Entry
The problem: Missing ICD-10 diagnoses on requisitions. Ordering physicians skip medical necessity documentation. Claim denied CO-11 or CO-50.
Our fix: Pre-submission requisition review + auto-query workflow to ordering physicians for missing ICD-10s. Fixed before claim leaves.
Result Finalization Delay
The problem: Claims batch-submitted end of week. Timely filing deadlines missed on delayed results. UHC, Medicare require 90 days — labs regularly miss.
Our fix: LIS webhook triggers same-hour coding + submission. Every claim submitted within 4 hours of result finalization.
Payer LCD Denials
The problem: Molecular and genetic tests denied on LCD medical necessity. Novitas L37822, Palmetto L38986, and 47 other active LCDs change quarterly.
Our fix: Live LCD tracking across 12 MAC regions. Pre-submission LCD compliance check flags mismatched ICD-10s before claim goes out.
Appeals Window Missed
The problem: Denials sit in a queue. 30-90 day appeals windows expire. Previous biller writes them off as uncollectable. Money vanishes.
Our fix: Same-day denial working. Peer-to-peer requests filed within 24 hours. Every appeal tracked to close-out. 78% average win rate on medical necessity appeals.
Total average leakage: $47K–$120K per month for a mid-size molecular lab. Most of it recoverable.
Get a Free Denial AuditWhat each test is actually worth after denials.
Reimbursement rates look great on paper. Then denials happen. Here's what independent labs actually collect per test — and how much they leave on the table.
| Test Category (CPT) | Avg Allowed | Denial Rate | Net Collected | Lost per Test |
|---|---|---|---|---|
| Basic Metabolic Panel (80048) | $11.60 | 10% | $10.44 | $1.16 |
| Comprehensive Metabolic Panel (80053) | $14.49 | 12% | $12.75 | $1.74 |
| Vitamin D 25-Hydroxy (82306) | $34.05 | 28% | $24.52 | $9.53 |
| Lipid Panel (80061) | $13.39 | 14% | $11.52 | $1.87 |
| Molecular Pathology (81479) | $2,180 | 47% | $1,155 | $1,025 |
| Genetic Testing Panel (81443) | $3,500 | 62% | $1,330 | $2,170 |
| Toxicology Confirmation (80307) | $97.75 | 31% | $67.45 | $30.30 |
| Anatomic Pathology (88305) | $65.20 | 22% | $50.86 | $14.34 |
If your lab runs 500 molecular tests per month, you're losing approximately $512,500 per year to denials. Most of it recoverable with proper LCD compliance, prior auth workflows, and appeal execution.
Live LCD tracking across all 12 MAC regions.
Local Coverage Determinations change every quarter. Novitas, Palmetto, WPS, and the rest each maintain hundreds of active LCDs. Miss one update, watch your denial rate spike overnight.
MAC Regions We Track
Recent LCD Updates We Applied
See what happens at each step.
Click through each stage to see what our team is doing while your claim moves.
Encounter details reach our team
The moment a test result finalizes in your LIS, we pull the requisition, patient demographics, insurance, and CPT-relevant data. No batch waiting, no end-of-day exports. Works with Orchard, LabWare, Sunquest, SoftLab, and most major lab platforms.
- Direct PM integration or secure upload
- Same-day encounter capture
- Automatic patient and payer verification
AI codes, certified coder reviews
Our AI runs the first coding pass in seconds, assigning CPT 80000-89999 codes and ICD-10 diagnoses based on the requisition and clinical notes. A certified coder reviews the tricky parts, molecular panels, PLA codes, medical necessity edits, and unlisted procedures, before the claim moves forward.
- AAPC-certified coders reviewing every claim
- Modifier 24, 25, 59, 79 splits handled
- Specialty edits applied automatically
Payer-specific scrubbing
Before the claim ever leaves our system, we scrub it against payer-specific rules, NCCI edits, and coverage policies. Anything that would trigger a denial gets caught here, not four weeks later.
- NCCI and medically unlikely edit checks
- Payer-specific rule engine (Aetna, BCBS, UHC, Medicare)
- Coverage and eligibility re-verified
Submitted and tracked in real time
Electronic submission through our clearinghouse. From that moment on, you can see the exact status of every claim in your dashboard. If a payer flags it, we know within hours and start working the fix.
- Direct clearinghouse submission
- Real-time status tracking
- Immediate denial and rejection alerts
Payment posted, ERA reconciled
When payment arrives, we post it, reconcile the ERA against your PM system, and flag any variance for your review. If the claim was denied instead, we are already working the appeal.
- Daily payment posting
- ERA auto-reconciliation
- Same-day denial follow-up
What outsourced laboratory billing looks like in the real world.
Averaged across our active client base. Individual results vary by specialty, payer mix, and prior billing setup.
Lab types we bill for every day.
Every lab type has its own coding rules, LCDs, and payer pain points. We are already fluent in these.
“We had eighteen months of aged molecular claim denials our prior biller had quietly written off. CureMed pulled the report, reworked the appeals with proper LCD documentation, and recovered just under $290K in the first quarter. We didn’t even know it was there to find.”
Questions labs ask before they switch.
How does outsourced laboratory billing work?
You send us test requisitions and results from your LIS through a direct integration or secure upload. We assign CPT 80000-89999 codes and ICD-10 diagnoses, scrub against LCDs and payer edits, submit electronically, post payments and ERAs, and handle prior auths, denials, and appeals. You keep visibility into every step through your dashboard.
How much does outsourced laboratory billing cost?
CureMed charges 4.99% of collections. That is the whole fee, no setup cost, no monthly platform charge, and no per-claim add-ons. The same rate applies whether you are a single-site clinical lab or running a multi-location reference lab. If we do not collect, you do not pay us.
How long does it take to switch billing companies?
Most labs are fully live within two to three weeks. We start with a free audit, then map the transition around your existing LIS and staff workflows. Nothing goes live until you have signed off on every step, and we run parallel during handover so no claims fall through the cracks.
What is a clean claim rate and why does it matter?
A clean claim rate is the percentage of claims accepted by payers on first submission without needing edits or resubmission. Higher clean claim rates mean faster payment, less rework, and lower staff burden. Industry averages sit between 75 and 85 percent. CureMed clients typically move to 96 percent or higher within the first two months, largely because of the AI plus certified coder review process.
Do you work with my LIS?
We work with most major lab information systems, including Orchard Harvest, LabWare LIMS, Sunquest, SoftLab, LigoLab, CGM SchuyLab, NovoPath, and PathologyWatch. If you use something less common, we can usually integrate within the first week of onboarding. If integration is not possible, we work through secure upload and it does not slow down the workflow.
Ready to switch to outsourced medical billing?
Send us a sample of your recent claims. We will send back a written audit showing exactly what a different biller would catch, at no cost.