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Thread: In office testing for skilled nursing

  1. #1

    Default In office testing for skilled nursing

    AAPC: Back to School
    Does anyone know if a patient is in a nursing home or skilled nursing will medicare will pay for dopplers done in a private practice? One of my providers said that if the patient has been in a nursing care facility for over 100 days that we can, however i have always been told that if a patient is in a skilled nursing or nursing home that we have to give them a script to have the "house" doctor set it up within there facility? If we can do them in the providers office is there a modifier that we would attach?

  2. #2
    Join Date
    Apr 2007
    Rochester, NY


    I haven't done skilled nursing billing in a few years, but the rules used to be that you had to bill the skilled nursing facility for the technical portion with a TC modifier and you billed the professional to Medicare with a 26 modifier. We had issues at our radiology practice where we did not know the patient was from a SNF. We would most times get payment from Medicare, then they would take the money back indicating there was another payer. We would rebill Medicare right away with the 26 modifier and then spend time trying to figure out which SNF the patient resided at. I believe the SNF is paid a daily rate for the patient by Medicare, so the SNF has to pay for the technical portion of diagnostic services out of that money.
    Thanks, Jill

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