Neurology & Pain Management Coding Alert

Question: When may we report the global fee for electrodiagnostic testing in a facility setting? Our neurologist has been using his own equipment to administer nerve conduction studies (NCS, 95900-95904) at the local hospital. If we bill these studies using the appropriate code, Medicare only reimburses for the professional component of the service. My understanding is that if the physician owns the equipment she uses for the tests, she is entitled to collect for the technical portion of the procedure as well.

Massachusetts Subscriber Answer: You are correct that the neurologist should be able to collect for the technical portion of a test if she uses her own equipment. But if the neurologist provides the test in a facility setting (such as a hospital), you cannot expect to receive payment for the technical portion of any procedure directly from Medicare.

Some procedures, including electrodiagnostic tests, are a combination of a technical component and a physician (or professional) component, according to Appendix A ("Modifiers") of CPT. For outpatients, if the physician owns the equipment she uses for testing, she may report the appropriate CPT code with no modifiers and receive the global fee for that procedure.

If the physician provides only the professional portion of the service (test interpretation only), she must report the appropriate CPT code (for example, 95900, Nerve conduction, amplitude and latency/velocity study, each nerve; motor, without F-wave study) appended with modifier -26 (Professional component).

The facility that owns the equipment used during testing will bill separately for the technical portion of the test by reporting the appropriate CPT code with modifier -TC (Technical component) appended (for example, 95900-TC)

But physicians providing services in a hospital or facility setting cannot claim the technical portion of a procedure regardless of whether they own the equipment. This is because, by law, hospitals receive compensation for the technical portion of all tests for Medicare inpatients as part of the diagnosis-related group payment.

For example, if the neurologist provides NCS in the hospital using her own equipment, you must claim only the professional component of the test (95900-26) because the hospital automatically receives payment for the technical portion of the test.

Similarly, if the physician's own technician (that is, a technician employed by the physician) performs the test in a facility setting, the physician nonetheless may claim only the professional component because Medicare rules require that payment for nonphysician services provided to hospital patients be paid only to the hospital. This requirement applies even if the physician performs the service for a hospital patient in his office.

You can receive reimbursement for the technical portion of a test in a facility if your practice arranges for a separate billing agreement with that facility.