Wiki ASC Billing

[Jane5711]

I am working for a company that is opening a Physcian owned ASC. Is the billing for the providers done on a CMS 1500 form and since the provider owns the ASC can we bill the global code, ie 93458 or should this be billed with the 26 for the provider and TC for facility.

Many thanks for any help...

Jane

 

[thomas7331]

You will need to bill your physician claims and ASC claims separately because you're billing for two different provider types - you can't bill a global code because the professional portion needs to be billed with the physician's credentials and the facility portions with the ASC's NPI and TIN (which likely will be different from the physician's TIN even if the ASC is owned by the physicians). Physician services are always billed on the 1500 form. The ASC might be billed on the 1500 or UB-04 form depending on your specific payer's requirements.

CPT and HCPCS codes such as 93458 that have a PC/TC split in the fee schedule should be billed with modifiers appropriate to the provider that is billing, but surgical codes that don't have PC/TC components won't have modifiers. The payers will know from the type of provider and the place of service whether you are billing for a physician service or for a facility service.

 

[Jane5711]

You will need to bill your physician claims and ASC claims separately because you're billing for two different provider types - you can't bill a global code because the professional portion needs to be billed with the physician's credentials and the facility portions with the ASC's NPI and TIN (which likely will be different from the physician's TIN even if the ASC is owned by the physicians). Physician services are always billed on the 1500 form. The ASC might be billed on the 1500 or UB-04 form depending on your specific payer's requirements.

CPT and HCPCS codes such as 93458 that have a PC/TC split in the fee schedule should be billed with modifiers appropriate to the provider that is billing, but surgical codes that don't have PC/TC components won't have modifiers. The payers will know from the type of provider and the place of service whether you are billing for a physician service or for a facility service.

Thank you for your response; greatly appreciate it.

 

[BunnyT51]

You will need to bill your physician claims and ASC claims separately because you're billing for two different provider types - you can't bill a global code because the professional portion needs to be billed with the physician's credentials and the facility portions with the ASC's NPI and TIN (which likely will be different from the physician's TIN even if the ASC is owned by the physicians). Physician services are always billed on the 1500 form. The ASC might be billed on the 1500 or UB-04 form depending on your specific payer's requirements.

CPT and HCPCS codes such as 93458 that have a PC/TC split in the fee schedule should be billed with modifiers appropriate to the provider that is billing, but surgical codes that don't have PC/TC components won't have modifiers. The payers will know from the type of provider and the place of service whether you are billing for a physician service or for a facility service.

Hello all I'm having sort of the same issue. I'm currently seeing the 93458(TC) being denied for the facility and paid for the physician 92458(26). I was told per CMS guidelines that for Medicare Advantage plans have to bill the ASC facility claims on a HCFA-1500 instead of the UB04. I keep getting a denial from Cigna advising: Services billed with Modifier TC on a professional claim with a facility place of service are included in the facility reimbursement. Please help me understand this denial and what needs to be done to correct this.