Mangaged care billing UB 92 example

Managed Care Billing Process:

The signed contract will include the MCO’s specific billing rules. Some third party payers require the UB92 form for filing the ASC facility fee. This should be clarified at contract negotiation time. Most payers that require the use of a UB92 form will accept the CPT and the standard ASC revenue code. It is important to be aware of incidentals that can be billed separately; all exclusions, special rules for bundling, handling of multiple services, multiple levels and bilateral services


UB92 Example for most payers

•Type of Bill: Always 831
•Revenue Code: 490 (ASC) (Note: most payers accept this revenue code for all line items)
•Procedure Code- Always use –SG modifier plus –59 or –51 as applicable
•Revenue Code- 320 Fluoroscopy or Interpretation Code with the modifier -tc
•Revenue Code- 270 Supplies - 99070

Itemized Supplies/Drugs Example:

If the payer requests a break down of CPT code 99070, miscellaneous surgical supplies, the following would be included as appropriate

Break Down of Supplies (Example)
Cost:______Price charged:(    )
A4550  Epidural Tray		Syringe:		J3490 Marcaine .25%
A4649:		Needle:		J1040 Depo-Medrol 80 mg:
Jelco		Pulse Ox:		J1030 Depo-Medrol 40mg
IV Kit:		O2 + Nasal Tubing:		J3010 Fentanyl 2ml
Tegaderm Dressing:		Sterile Surgical Gloves:		A4645 Isovue 200mg Iodine:
Adaptor:		J2250 Versed per 1 mg