Wiki Pain Management billing duplicate CPT codes as facility fees. (64490)

[Julie.Wallace@afics.com]

I have been noticing that some pain management groups are billing their facility fees as duplicate CPT injection codes. For example:

64490-50: Bilateral paravertebral Facet Joint Injection
64491-50: Second level, with fluoro.
Then they bill another:
64490-50 with another 64491-50 as facility fees.

How should these providers be billing their facility fees for their injections?

Thank you for your help!!

 

[thomas7331]

Facilities will use the same codes on their claims as the physicians who are providing the professional services. These are not duplicates because the physician is only billing for their professional work and the facility is only billing for the use of the equipment and space, even though the CPT codes are the same. The facility claim would be under a different provider number that is credentialed with the payer as a type of facility and the payer should recognize that this is not a duplicate service.