AAPC - Back to school
Results 1 to 3 of 3

Thread: Medicare Allowable

  1. #1

    Question Medicare Allowable

    AAPC: Back to School
    I posted this in the local chapter but didn't get any help so I am hoping that a bigger forum might have some insight...

    This might sound like a crazy question but I will explain why I have it. I have billed for two companies. One was a large corporation that loaded the fee schedules for everyone, so if a claim under or over paid it was really easy to tell. The other company I worked for didn't have a fee schedule and seldomly cared if something paid incorrectly... I now am billing for a couple of my own doctors and what I thought I knew about the Medicare allowable I may be misunderstanding.

    On the PDF that Medicare has on their website for the 2010 allowables it has two allowables for many codes. One of those allowables is for facility. When do we go off that allowable? I thought I was once told that is for a doctor doing a procedure at like his office or something similar. But I have an out patient hospital procedure done and Medicare used the facility allowable, not the other one. There is a big difference in the reimbursement.

    If it should have been the other allowable is there certain documentation that Medicare will be looking for to show it isn't the facility allowable?

    Thanks for your input, hopefully I don't sound too crazy asking this

  2. #2
    Join Date
    Apr 2007
    Columbia, MO


    The facility allowable is for procedures performed in the facility setting as opposed to the office setting. The amount is different due to the cost to the physician is different in his office he is out the overhead for his services and at the facility the overhead is the facility's cost.

    Debra A. Mitchell, MSPH, CPC-H

  3. #3


    Thank you!!

Similar Threads

  1. Allowable amount of units - Does anyone know where
    By alisa1072 in forum Hematology/Oncology
    Replies: 2
    Last Post: 12-18-2014, 10:21 AM
  2. Allowable ICD-9
    By vnorman in forum Medical Coding General Discussion
    Replies: 5
    Last Post: 07-21-2010, 02:33 PM
  3. Medicare allowable for Q0081
    By SKR1944 in forum Medical Coding General Discussion
    Replies: 0
    Last Post: 05-13-2010, 01:37 PM
  4. Allowable ICD-9
    By vnorman in forum Diagnosis Coding
    Replies: 0
    Last Post: 01-20-2010, 07:16 AM

Posting Permissions

  • You may not post new threads
  • You may not post replies
  • You may not post attachments
  • You may not edit your posts

Enjoying Our Forums?

AAPC forums are a benefit of membership. Joining AAPC grants you unlimited access, allowing you to post questions and participate with our community of over 150,000 professionals.

Join Now Continue Reading Without Full Access

Already a Member?


Close Message

In addition to full participation on AAPC forums, as a member you will be able to:

  • Access to the largest healthcare job database in the world.
  • Join over 150,000 members of the healthcare network in the world.
  • Be a part of an industry leading organization that drives the business side of healthcare.
  • Save anywhere from 10%-50% with exclusive member discounts on courses, books, study materials, and conferences.
  • Access to discounts at hundreds of restaurants, travel destinations, retail stores, and service providers. AAPC members also have opportunities to save on heath, life, and liability insurance.
  • Become a member of a local chapter and attend regular meetings.