nancy Posted Tue 06th of August, 2019 17:29:04 PM
you have two bills surgery center for 55866 and professional how would you find the right fee for each one
SuperCoder Answered Wed 07th of August, 2019 07:24:47 AM
Thank you for your question.
The provided documentation is not clear. Could you please provide some clarity on the above? Kindly elaborate the concern of your query.
Based upon the above presented documentation, we are assuming that the procedure 55866 was performed in the Hospital setting since the Global period of the CPT® code 55866 is 90 days (Major Procedure). As per CMS, CPT® code 55866 does not have a PC/TC component; therefore, provider cannot bill for his services with modifier-26 (Professional Component). In such cases, the provider gets reimbursed for his part of services from the facility where serviced has been rendered.
nancy Posted Wed 07th of August, 2019 10:19:17 AM
I have a ambulatory surgery bill that is billing globally for 55866 at $148,479.00 and can not produce an itemized bill . zip code 92780. Trying to figure out how I can price this out of network claim
SuperCoder Answered Thu 08th of August, 2019 04:17:40 AM
Thank you for providing additional information.
As per CMS, CPT® code 55866 (Laparoscopy, surgical prostatectomy, retropubic radical, including nerve sparing, includes robotic assistance, when performed) is not a Qualified ASC service.
The National OPPS Fee for CPT® code 55866 is $7,741.63
Based upon the ZIP code 92780 (Tustin, CA), the OPPS fee for CPT® code 55866 is $7,741.63
Also, the National MPFS for CPT® code 55866 is $1,505.71 (Facility/ Non-Facility)
Based upon the ZIP code 92780 (Tustin, CA), the MPFS fee for CPT® code 55866 is $1,505.71 (Facility/ Non-Facility)
The above provided dollar value $148,479.00 for code 55866 seems incorrect.
Kindly get in touch with your respective payer.
Hope that helps.