Medicare Billing Process
A provider number is applied for by the ASC and issued by the Medicare carrier after approval from the State and the regional CMS carrier. This supplier number is applied for under the ASC Tax ID. Claims cannot be billed to Medicare for facility fees until the provider number is given by CMS regional and the actual billing number assigned by the carrier. The effective date is the date of survey compliance.
Once approval is received, facility fees are billed to Medicare on the standard HCFA 1500 form using the CPT code with the modifier –SG. Place of service is 24 (ASC)
Type of Service
Surgical services billed with the ASC facility service modifier SG must be
reported as TOS F. The indicator F does not appear on the TOS table because its
use is dependent upon the use of the SG modifier.
On the HCFA 1500 list:
• CPT Code + SG modifier
• List highest group first
• Use -59 as applicable based on LMRP for multiple procedures or additional levels of the same procedure
• Bilaterals - Use –50 (units 1) or RT/LT by line (increase fee x 2)
Ambulatory surgical center billing code guidelines and how to get payment from insurance. ASC denial, CPT CODES , Authorization and referral Guide. Multiple procedure, Surgical procedure tips. What to get the correct reimbursement in ASC billing setup. SNF billing Guide, tips to use correct CPT AND POS.
Wednesday, July 28, 2010
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