AmBaseer
Guest
I work for a portable Xray/ultrasound provider. We service mainly residents of assisted living or nursing facility and also home bound patients. So we bill the CPT codes with place of service codes 12 , 13 or 32 . We never have any issue with Medicare billing in this manner, but the advantage plans like Aetna and Blue Cross, have been denying claims saying "not reimbursable when done at this place of service". They say the facility itself should bill them. I've explained that we transport the equipment to the facility/home and set it up and then do the exam and our doctors read and interpret the report so we bill the global code without modifier, but they still deny it. Some like Humana will pay it if we send the claim as two claims- one with TC and one with 26 modifier , but Blue Cross pays only the 26 and says the facility should bill the TC. Someone suggested using POS 15 and we did get a couple paid with that but our administrator doesn't want continue using that as his understanding of mobile unit is that the equipment is fixed in a vehicle, like a trailer and the exam is done inside that vehicle/unit and not actually in the patient's home or room in the facility.
I'm a complete loss for what to do. Is there any other way to code these? I'd appreciate any advice, and your thoughts on this issue.
I'm a complete loss for what to do. Is there any other way to code these? I'd appreciate any advice, and your thoughts on this issue.