Wiki Can the practice bill a patient for xray reading, if they are using a outside source they pay for? And if so, what code would you use?

Can the practice bill a patient for xray reading, if they are using a outside source they pay for? And if so, what code would you use?

Who owns the x-ray equipment? If you're billing for both the technical and professional component, then you'd just bill the global x-ray code. (i.e - no TC or 26 modifier)
 
The practice owns the equipment. We send it off to be read and pay for the reading. I didn't know if there was a code we could use to recoup some of the money we are paying.

If you bill the x-ray as a global charge (no TC or 26 modifier), you're getting paid for the reading as part of the x-ray reimbursement.
 
Example using 73502 and Medicare reimbursement:

If you billed only for the technical component, 73502-TC would be reimbursed $37.37. Then the company billed the reading and 73502-26 would be reimbursed $11.07.

However, if you are billing globally, your reimbursement is $48.45. The cost of the reading is built into your global reimbursement.
 
I'm sorry, I'm not sure I understand. The reimbursement for a xray is not very much if we are seeing a patient and we bill a 99213 and a 71046.

Are you billing 71046-TC or just 71046? Your reimbursement already includes professional component if you bill CPT 71046.

The professional component reimbursement for CPT 71046 isn't very high. For example, the Medicare rate for the professional component of CPT 71046 is $10.73.

If you're paying someone more than $10.73 to read that x-ray for a Medicare patient, you're losing money on it every time. You'd be better off billing for only the technical component & having them send their own claim for the professional component.

Using Medicare rates as an example again...

CPT 71046 total Medicare value: $34.61

The technical component is worth $23.88, and the professional component is worth $10.73. $23.88 + $10.73 = $34.61


You can bill 71046-TC and get $23.88, while the radiologist bills 71046-26 and gets $10.73. Or you can bill 71046 (no modifier) and get the full $34.61 which includes reimbursement for the professional component.

If I were you, I'd examine the fee schedules for all of my contracted payors. I'd want to know if I was losing money by paying someone else to read the x-rays. You might be better off making them bill their own professional component.
 
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