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Need Hospital Billing Assistance

  1. Default Need Hospital Billing Assistance
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    I am a pro fee auditor and know little to nothing about hospital billing. We have a client, hospital, that would like to contract providers to read their EKGs. This would be a purchased service. They, hospital, want to know how would they bill this. Since I know nothing about hospital billing I do not know what to tell them and cannot find anything in research. Would they use the same code as a practice, 93000? How would they acknowledge the read/interpretation was a purchased service? Any help would be greatly appreciated.

  2. #2
    If the hospital contracts for the pro fee...than you would use that dr's npi and tax id number when billing on a hfca…..add 26 modifier to the pertaining cpt code.

  3. #3
    oh yes...they would the same cpt code with a 26 modifier.

  4. Default
    Quote Originally Posted by reawagner View Post
    If the hospital contracts for the pro fee...than you would use that dr's npi and tax id number when billing on a hfca…..add 26 modifier to the pertaining cpt code.
    You would not add a 26 modifier as the pro fee code would be 93010.

  5. #5
    Purchased services as in they will handle the billing? Then its CPT 93000 that covers the equipment and professional service
    CRC (2018), CPC-P-A (2016), COC-A (2016), CPC-A (2015), PAHM (2010)
    Contract/Fee Specialist - Remote

    20 years health insurance experience: Audit, Claims, Customer Service, Payment Policy, Provider Relations, and Reimbursement

  6. #6
    Default pro fee
    pro fee...add modifier 26.

    Who's equipment is being used? equipment is billed with a tc modifier.

    if the provider owns his own equipment then they can bill separately with billing modifier tc.

    You cannot bill modifier 26 and tc together.
    If some one else provides the equipment other than the hospital or physician than the equipment maybe billed by its self using the TC NPI NUMBER AND TIN.

    The hospital can bill and get paid the tc part of the claim...the contracted doctor would need to bill the hospital. Purchased services I believe is used from one entity to other if they are under a big hospital system purchased services would like be an accounting transfer one debit/credit from one hospital to the other... hope this helps.


  7. #7
    Default pro fee modifier 26. Technical modifier is tc. Who owns the equipment?
    your more than welcome to call me if you need to.

    send me a private email.

    Thank you.

    Rea Apgar-Wagner

  8. Smile 93000 Behavioral Health Practice - How to bill
    We are a behavioral health practice considering adding a room and provider specifically to perform EKGs. Is this code billed with units? I ask b/c the allowable is about 17.50. That seems low but perhaps that is correct?

    Any information would be appreciated!
    Thank you,
    Cindy Larson, RCC, CPC, CPCP

  9. #9
    Default Looking for contract billing
    We are a small practice and our doctor reads and interprets EKGs done in our local emergency room.

    We are overwhelmed by the burdens of billing for hundreds of patients and cannot focus on the day to day demands of patients, insurances and billing.

    Can anyone recommend a contract biller that would work with us?

    Please private message me.


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