Wiki billing 93971 and 93306

[CBHospital]

New to this feed so not sure if this is the correct place to post this question. We are a critical access hospital and recently started billing for the professional fee for CPT 93971 and 93306. We are getting an error message on 3M software and Medicare is erroring out this charge saying that the code is inherently bilateral and should not be billed more than once for the same dos. An outside doctor is reading the xrays but we are billing for him. We are billing with a 26 modifier. Can anybody help me with why they do not want to process the professional fee on these claims? Thank you

 

[CBLENNIE]

Do you know if the physician you are billing these professional fees for has elected OP Services: Standard Payment Method (Method I) or Option Payment Method (Method II)? If they elected Method I you cannot bill for their services, the provider is supposed to submit their own OP professional medical services claims for payment under the Medicare PFS.

If they elected Method II have they completed the paperwork required to reassign their billing rights to the CAH? The CAH must forward the Medicare Enrollment Application: Reassignment of Medicare Benefits (CMS-855R) to your MAC, the CAH needs to keep the original form on file. If the provider did complete this paperwork, has it been submitted to the MAC and has MAC finished processing the request?

Additionally for Method II, these services need to be billed on a UB-04 and show the professional services separately, with the appropriate HCPCS/CPT code with one of the rev codes from the professional fee code ranges 096x, 097x 098x.

You don't specify which code is erroring out that it is inherently bilateral, however I'm guessing you are referring to 93971, which is actually the unilateral code, and the bilateral code is 93970.

If none of what I've said here helps you I'm not sure where to direct you beyond CMS's website for Critical Access Hospitals Center billing.