Wiki CMS SE17023

[AMJ1892]

Hello, does anyone have any insight on this article? We are going back and forth if this applies only to Medicare claims. We are billing pathology claims and we want to make sure we are billing the correct DOS. When billing for the professional component (26 modifier) are we supposed to be using the date the specimen was interpreted or do we use the date of the procedure when the specimen was removed? Is this across all insurances or just Medicare. Any insight would be helpful!

 

[jkyles]

Hi there, all MLN Matters articles include details about the target audience and which part it applies to under the Provider Type Affected section.

This MLN Matters Article is intended for physicians, non-physician practitioners, and others submitting claims on a CMS-1500 form or the X12 837 Professional Claim to Medicare Administrative Contractors (MACs) for reimbursement for Medicare Part B services.

Remember that aside from certain plans like Medicare Advantage, private payers do not have to follow CMS' rules.

 

[AMJ1892]

Hi there, all MLN Matters articles include details about the target audience and which part it applies to under the Provider Type Affected section.



Remember that aside from certain plans like Medicare Advantage, private payers do not have to follow CMS' rules.

That is what I thought! thank you for the reply