Charge for medical supplies for in office procedure??

Messages
4
Best answers
0
I am wondering if a provider does a procedure like a Tenotomy (23405-52 or 27006-52) in the office, if he can charge the patient for supplies for the procedure. By not doing this in a surgical center or hospital he must supply the supplies himself and will get paid a reduced fee because of this. Are these billable to the insurance company (under what code?) or can he charge patient outright and not bill the insurance for the supplies?
 

mitchellde

True Blue
Messages
13,492
Location
Columbia, MO
Best answers
1
You cannot charge for supplies that are a necessary part of the procedure that is built in to the procedure reimbursement. You provider is not being paid less for performing procedures in the office setting, as long as the procedure is approved as an office based procedure. The fee schedule is different for procedures performed in the office setting than when performed in a facility setting. When performed in an office setting the reimbursement is global in that the provider is being compensated for the surgical service as well as the use of the office and supplies. When the provider performs a procedure in the facility setting the reimbursement is for the surgical service only so it is most usually less than when performed in the office.
 
Messages
4
Best answers
0
Where did you get this information? I'd like to show it to the provider. To my knowledge he would be paid less because it's in an office vs. surg center and also because he is billing a reduces procedure w/ modifer 52. They often don't even pay enough to cover the supplies cost.
 

csperoni

Expert
Messages
374
Location
Selden
Best answers
1
For the codes you provided 23405 & 23406, the RVU is the same wheter in office or in a facility, so he would be paid the same, not more OR less. This information is available on the CMS website.
I'm no ortho coder, but my first question would be why you are billing -52 modifier (which will definitely result in less payment)??
 
Top