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Facility Billing

Tina Posted Tue 27th of October, 2015 13:14:02 PM

I have a question for ASC facility billing with Medicaid. They are advising we need a modifier to bill for a colposcopy? 45378, I know the professional billing uses modifier "AG". What does Medicaid require for the facility part of the bill?

Tina Posted Tue 27th of October, 2015 13:14:47 PM

sorry meant colonoscopy

SuperCoder Answered Wed 28th of October, 2015 06:34:33 AM

Hi,
Please elaborate your question. What is your exact requirement?
You are billing professional component with AG modifier and your requirement is for technical component?

Tina Posted Wed 28th of October, 2015 17:14:58 PM

Billing Medi-cal for facility charges. For example we are billing on a UB04 for the use of the facility for a Colonoscopy. Medi-cal is requiring a modifier, for the procedure. I mentioned modifier "AG" since it's another required Modifier for Medi-cal on the physician's charges. But not for facility charges. The procedure does not have a technical component.

Tina Posted Wed 28th of October, 2015 17:17:14 PM

So my question is Medi-cal requires a modifier, what modifier would be appropriate for CPT code 45378 on the UB04 facility billing to Medi-cal?

SuperCoder Answered Thu 29th of October, 2015 08:55:59 AM

This query is under discussion. We will get back to you soon.

SuperCoder Answered Thu 29th of October, 2015 08:55:59 AM
This query is under discussion. We will get back to you soon.
Tina Posted Tue 03rd of November, 2015 19:59:20 PM

Any updates to my question?

SuperCoder Answered Thu 05th of November, 2015 02:29:20 AM

Thanks for your patience. Modifier SG is appended to CPT codes provided by an ambulatory surgical center, which means facility fee only. This modifier is effective for services on or after January 1, 2008, the SG modifier is no longer applicable for Medicare services, but most other payers want this modifier to be appended to the facility claim. Hope this helps.

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