Wiki Pass Through Billing

[aleigh]

Scenario question regarding pass through billing I am needing some help on.

Pathologist is ordering 5 IHC stains, the TC is being performed at a hospital lab and pathologist is rendering PC.
Hospital does not want to bill insurance TC, so they will bill pathologist for these services. Can pathologist pass through these exact charges to insurance? I am reading a lot of conflicting information online.
Thanks for any insight.

 

[aleigh]

I have found this which seems to support that he can bill. How does one indicate it is a pass through charge, modifier 90?

3. Purchased service billing. Medicare allows the physician to purchase the technical component of the pathology services from an outside reference laboratory. The purchasing of the technical component is only allowed if the practice reads its own slides. In this scenario, there are two options:
a. The technical component is billed by the laboratory and the practice only bills for the professional component.
b. The technical component is billed by the physician who purchases it. In this scenario, the physician can bill Medicare only the exact amount charged to the practice for the technical component by the outside lab. In other words, if the laboratory charges $10 for the slide prep, then the practice can only bill Medicare $10 for the technical component.
• No mark-ups are allowed.
•The technical component must be billed on a separate claim form. It can't be billed on the same claim form that contains the billing for the professional component.
• No global billing is allowed if either component is purchased. Global billing refers to billing the pathology service with no modifiers.