youngva462@gmail.com
Networker
How can I tell if a CPT/HCPCS code is considered a professional fee or a facility fee code? Is there a tool or chart that addresses this?
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Wiki Is there a tool to determine if a code is professional or facility?
- Thread starter youngva462@gmail.com
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Pam Warren
True Blue
Medicare's Physician Fee Schedule--you can look at whether there's a professional -26 or technical -TC component to the code. Some codes are inherently professional (Like 93010) or inherently technical (93005) which you can determine by the CPT description.
Some professional codes like surgeries are billed out on the UB for OPPS claims, so sometimes the modifier usage isn't the defining factor.
You also have to figure out who is doing the work and where. So in a hospital outpatient department, a respiratory therapist is providing pulmonary function tests. That gets billed on the UB, and the pulmonologist is reading them (-26 modifier) which is billed on the 1500. If it's all being done in a practice, and the provider owns the equipment, you'd bill globally on the 1500.
Some professional codes like surgeries are billed out on the UB for OPPS claims, so sometimes the modifier usage isn't the defining factor.
You also have to figure out who is doing the work and where. So in a hospital outpatient department, a respiratory therapist is providing pulmonary function tests. That gets billed on the UB, and the pulmonologist is reading them (-26 modifier) which is billed on the 1500. If it's all being done in a practice, and the provider owns the equipment, you'd bill globally on the 1500.
mommys2girls
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Hi Pam, can you please provide some additional clarification on this. I am newer to the coding industry.
When you say look at the Medicare Physician Fee schedule, I filtered by PC/TC 2. That will give me the inherently professional codes correct? Or should I also be using those with PC/TC indicator 1 and showing can be billed with a-26 mod as well?
Thank you!
When you say look at the Medicare Physician Fee schedule, I filtered by PC/TC 2. That will give me the inherently professional codes correct? Or should I also be using those with PC/TC indicator 1 and showing can be billed with a-26 mod as well?
Thank you!