Wiki Apheresis by physician at the hospital

[amsmith]

My physicians have been asked to oversee Apheresis (36514 for the most part). I have seen conflicting information regarding modifier 26 as these services will be performed inpatient and outpatient in the hospital setting. CPT states that we should use 26, Medicare and Medi-Cal do not advise this. We have pulled our contracts and none of them advise the 26 either. One of my well seasoned physicians suggests that there is not a payment for the physician side (although it appears fairly lucrative). Is there anyone billing for this? If so, do you have any tips for me?

 

[sharynwolfe]

me too

So did you get anywhere with this question? I know this was posted a long time ago but my physicians came to me with this same question and I am trying to give the correct answer.
Thank you.

 

[kadesiag]

You should use the 26 modifier

 

[thomas7331]

I disagree, this code has a PC/TC indicator of zero on the Medicare physician fee tables, which defines it as a physician service code: 'The concept of PC/TC does not apply since physician services cannot be split into professional and technical components. Modifiers 26 and TC cannot be used with these codes.' If performed in the hospital setting, this should reimburse at the facility rate which is substantially less than the rate that would be paid in a non-facility setting, but there are no separate 26 vs. TC rates.