Wiki Billing multiple pain levels

[kathy kaelberer]

I was asked this question and believe the answer is no since it would constitute a dual fee schedule. Wondering what others think and would appreciate any input.

My question is when billing multiple level pain injections, can you bill CMS & BCBS a lower amount for the 2nd procedure to offset your contractual write off since the 2nd level is paid at 50%?

Example is if you bill a 2 level transforaminal injection: 64483 @ $635.95 (1st level), 64484 @ $635.95 (2nd Level) & C-Arm 77003-tc @ $190.00 to all commercial insurances. Can you then turn around and bill CMS/BCBS 64483 @ $635.95 (1st level), 64484 @ $317.98 & 77003-tc @ $95.00

 

[capricew]

Yes you can --- be careful though

hypothetical scenario....
On your first level you bill 800.00 (cms reimb + 515.00)

on second level ...you have to bill as high as the reimbursement rate for you first level, so you have to bill at least 515.00 on the second line even though your reimbursement will on be
515.00 at 50% = 257.50

if you dont bill as high as your first level reimbursement and you only bill 400.00 (half of what you billed for primary level) medicare will reduce your billed amount on the second level by 50% so instead of getting full reimbursement at 50% (275.50)
in this scenario you will get only 200.00 because they cut your billed amount in half

so your billing should like similar to this using the above numbers

64483 rt l3-4 724.2 800.00 allowable 515.00
64484 rt l4-5 724.2 600.00 allowable 515.00 x 50% = 257.50
64484 59-rt l5-s1 724.2 600.00 allowable 515.00 x 50% = 257.50

dont cut yourself short...

Hope this helps...caprice, cpc

 

[kathy kaelberer]

Can you bill this way in a free standing ASC? My thought was that ASC's are like an Outpt hospital setting and you must bill every insurance the same.