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General Surgery Coding Alert

Reader Question:

Know When to Apply Anti-Markup Rule

Question: Our surgical group sometimes purchases lab tests from an outside lab and bill Medicare. Evidently Medicare requires us to indicate on the claim form in Box 20 if a service was purchased from an outside lab and what the purchase amount is. My question is regarding our charge amount that we report in Box 24-F: Can this fee exceed what we reported in Box 20, or does it have to equal or be of lesser value? How does this impact billing other payers for the same service since we can't have two separate fee schedules for Medicare and other payers?Tennessee SubscriberAnswer: There is no longer a "purchased diagnostic test" rule, according to CMS. Instead, you need to take into account an "anti-markup rule."A physician must check box 20 'yes' and enter a dollar amount only if the anti-markup rule applies to a particular claim. When a pathologist purchases the [...]

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