Wiki Facility payment vs Physician payment

[gvarnes7]

Hello...I need some help please. I do billing for an ENT group....my question is; If my provider performed a sinus surgery at POS 22 or 24 will he be reimbursed at the facility contracted rate or the physician contracted rate?

 

[mikhaila]

Hello,

The article at the link below is a good source and gets into the OPPS, ASC and physician coding and reimbursement and provides scenarios.

https://www.aapc.com/resources/outpatient-facility-coding-and-reimbursement

However, in short, for POS 22 an outpatient facility affiliated with a hospital, the provider would be reimbursed at the facility contracted rate.
See link below with short article which provides scenario.

https://www.aapc.com/blog/43191-place-of-service-22/#:~:text=Answer%3A%20Essentially%2C%20you%20may%20report%20either%20place%20of,the%20same%20%28the%20facility%20rate%29%2C%20in%20either%20case.

For POS 24, that would depend on how you answer if the ambulatory surgical center (ASC) is affiliated with a hospital or if it is an independent, freestanding ASC with no financial ties to the hospital.
* ASC affiliated with a hospital - facility contracted rate
* Freestanding, independent ASC with no financial ties to a hospital - physician contracted rate

The snip below is from the article cited in the first link.