Wiki Who Can Bill for G0250

[reac2005]

I'm looking for documentation on who can bill for
G0250 -
Phys review, interp and pt mgt of home INR testing for patient with either mechanical heart valve(s), chronic afib , or venous thromboembolism who meets Medicare coverage criteria; testing not occurring more frequently than once a week; billing units includes 4 test. G0250 continues to mean per 4 test and should be billed no more frequently than once every 4 weeks.

My office has ancillary staff the physician want to review the results and call these patients and/or message them if abnormal results based on algorithm the physician has set up. I have read thru as many polices I can get my hands on and cannot find who can perform outside of physicians. If physician is not involved per say (results normal) and a RN reviews and call the patient or make changes based on the algorithm can this still be billed? Does anyone have anything they think and help me clarify?

 

[thomas7331]

Because this code description is that of a physician review, and is listed in the Medicare Physician Fee Schedule as a status '2' code - professional component only code - this would only be billable (to Medicare) as a service personally performed by a physician or qualified mid-level provider, and not as an 'incident to' service of the office staff. Other payers may use the code differently though, so you may wish to check with your specific payer policies.