Wiki ASC Implant Question

[Cassi3434]

There is a discussion in our clinic on the proper way to bill implants at an ASC to different contracted insurances. Are we required to bill the implant (L8699) with the markup that the specific insurance is stating they will pay? OR should the markup be the same across the broad for all insurances? I feel that it is improper billing to charge 1 insurance one rate and the 2nd insurance something different for the same item. Thank you for any input you can provide.

 

[thomas7331]

There is a discussion in our clinic on the proper way to bill implants at an ASC to different contracted insurances. Are we required to bill the implant (L8699) with the markup that the specific insurance is stating they will pay? OR should the markup be the same across the broad for all insurances? I feel that it is improper billing to charge 1 insurance one rate and the 2nd insurance something different for the same item. Thank you for any input you can provide.

I agree with you, the same item should be charged the same at the same amount to all payers, unless perhaps your payer contract specifically states that you must bill the dollar amount that represents the invoice price plus the markup that your contract allows.

L8699 is an unlisted code, so the code itself may have different charge amounts depending on which implant it is that was used in that particular procedure. But the same implant should be charged the same way in all cases, in my opinion.