Wiki NPP and radiology coding. PLEASE HELP!

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NEOSM507

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We are currently being denied by Medicare for all x-rays billed under par participating PAs as they are not qualified to perform these services. In researching, I am realizing that they are supposed to be charging for the professional component of the x-ray (modifier 26) and the supervising physician bills for the technical component. (modifier TC)

My question is, when billing Medicare under the PA directly (NOT incident to), they dont require a supervising physician and are frequently seeing patients without direct supervision. So who would we bill the technical component under?

Thank you
 
NPP and radiology coding

From my understanding the NPP or PA would bill under their NPI for all services if they performed services without a supervising physician/direct supervisor in the building? This makes me think that this could be a state issue with requirements of what the PA is able to bill. I am in Alabama and that is how we would handle this situation. The only way to bill it as incident to is if the physician was in the building and direct supervision requirements were met. Not sure if this helps or not. :)
 
Diagnostics are not performed incident to

Hi,

If you are receiving denials and/or recoupments of payment for radiology services supervised by nonphyisicians, I suggest you look to the Medicare guidelines for supervision of diagnostic services. Novitas Solutions has an quick reference page explaining the supervision required for diagnostic services at https://www.novitas-solutions.com/w...state=1bs1uay5tt_4&_afrLoop=2670335997714701#!. You can also find more detail on this in Section 80 of Chapter 15 of the Medicare Benefit Policy Manual (cms.gov/manuals). Most of your office radiology services probably only require the physician's general supervision of the technician performing the service. The physician is not required to be present at the time of service but is responsible for the training of the nonphysician personnel who perform the services (e.g., ongoing education of technicians) and maintenance of necessary equipment and supplies.

Private payers may or may not follow these policies.

I hope this helps and that the payer allows payment of corrected claims.
Cindy
 
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