Wiki Provider Based Billing

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lenaraamackerjackson@yahoo.com said:
Good Morning,
Should injections, X-ray's, and EKG's be billed on both CMS 1500 forms and UB forms for provider based billing?
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For x-rays and EKGs and any other diagnostic tests, the hospital will bill the technical component on the UB form. If the physician who performs the interpretation is a hospital employee or a physician who is contracted by the hospital to do the readings, then hospital will bill the professional component on the 1500 form. Sometimes though the hospital will use outside physicians to read the tests, in which case those physicians may do their own billing of the professional component.

Similarly to the above, for injections and other procedures, the physician performing the procedure will bill their services on a 1500 form. The hospital will bill the facility fees on a UB form, and this claim will include all charges for the use of the facility location where it took place (OR, clinic, or procedure room) plus any supplies, drugs, anesthesia costs, labs, etc., that accompanied the procedure itself.
 
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G0463 is used on the facility claim corresponding to all new and established outpatient E&M visits in the range from 99201 through 99215. I'd also add that there are cases where the facility may bill G0463 when there is no corresponding physician E&M bill if it falls into the global period of a surgery, since the global rules apply only to the physician's portion.
 
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