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Facility Fee's for FNA

Venkataraman Posted Wed 23rd of July, 2014 19:46:22 PM

Our practice has been performing Ultra sound directed fine needle aspirations for ENT physicians in their ASC's. What modifier will they use to our cpt codes to obtain facility fee's?

Thank you!

SuperCoder Answered Thu 24th of July, 2014 02:08:33 AM

Which CPT do you use for the procedures performed?

Who owns the equipment ASC Or your practice?

Venkataraman Posted Thu 24th of July, 2014 10:02:23 AM

The CPT codes used for USFNA procedures are 76536, 76942, 10022, 88172 & 88173. My practice owns the equipment.

SuperCoder Answered Mon 28th of July, 2014 03:46:27 AM

Code that are subject to professional-technical split, the facility who owns the equipment usually gets reimbursement for their expense and the provider who interprets the result gets their reimbursement by appending modifier 26 with the billed code.

As per CMS guidelines, ASC, or ambulatory surgical centre reports their charges on a CMS-1500 form with an SG modifier (ASC facility service). Claim lines reported with modifier SG indicate a facility charge and are reimbursed as a facility claim.

Depending upon your financial arrangement with ASC they may bill for facility charges by appending SG modifier and the provider who is performing the professional component will have to bill the code with modifier 26.

Thanks !!

Venkataraman Posted Sun 04th of January, 2015 21:40:10 PM

The new CPT codes for HPV is a little confusing; Do we code 87624 if on the first step we check the specimen for any high risk HPV and when positive, we should bill 87625 if the physician is wants to know if 16 & 18 are present; is that correct?

SuperCoder Answered Mon 05th of January, 2015 03:24:59 AM

Thanks for your query.

Your current questions is different from the last question thread. Please post this questions as fresh post. Thanks !!

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