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Cardiology Coding Alert

Pacer Checks Update:

CMS Modifier -TC Billing

Published on Mon Oct 27, 2003

If you're concerned about how to report the technical component (-TC) to Medicare for pacemaker checks on equipment you don't own, CMS says not to worry. You don't have to labor over actual practice-expense costs when you report these services.
 
(See "How Are You Billing Those Pacer Checks? What You Should Report When You Don't Own the Equipment" in the September 2003 Cardiology Coding Alert for more on pacer analysis billing.)
 
"Because Medicare practice costs are based on a typical practice, we do not require physicians to document actual costs incurred for furnishing a service," says Ellen Griffith, CMS spokeswoman. "Medicare pays the same amount for the technical component, regardless of whether the equipment is newly purchased, fully depreciated, purchased at a discount or received free as a gift."
 
The relative value units (RVUs) for the technical component of pacemaker analysis codes 93731, 93732, 93734 and 93735 are 0.52, 0.54, 0.37 and 0.47, respectively. Therefore, the payment is nominal, ranging from about $13.61 to $19.87, Griffith says.
 
The bottom line: You can bill Medicare for the technical component of device checks performed on equipment that is not owned by the practice. When pacemaker company reps perform the checks, you would not bill the technical component.
 
Remember that Medicare payers do not calculate practice expense payment simply by adding up all the direct costs, CMS states. Payers take into account various indirect costs, scaling factors and budget neutrality when reimbursing for these expenses.

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