Wiki Hospitals do not bill 93000 due to HIPAA transaction sets?

[ssoisson]

Is this a true statement?

I found this in the comments of the 2020 OPPS proposed rule:

Hospitals do not bill 93000 due to HIPAA transaction sets, as it is a CPT code that includes both the professional component and the facility component. Rather, hospitals bill 93005 for the EKG tracing and if the hospital also bills the professional component, then that code is 93010.

 

[thomas7331]

Yes, that is correct - OPPS only reimburses the technical component to facilities. The professional component is reimbursed under the physician fee schedule. So a facility billing under OPPS rules would never use 93000, that I'm aware of.

 

[ssoisson]

Thank you! I am also looking for opinions about the 70 shoppable services in the OPPS Proposed Rule. Have you seen that information yet?