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76942 in ambulatory surgery center with own equipement

  1. Default 76942 in ambulatory surgery center with own equipement
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    Recently a consultant has convinced one of our doctors into purchasing the ultrasound equipment in an attempt to bill for the global on 76942 at a ambulatory surgery center, as he was tired of getting paid only for the professional component. When we tried to bill Medicare they rejected the claim for place of service invalid and afford no appeal rights, which boils down to you forgot the modifier 26 in CMSanise. I called Medicare and spent well over an hour attempting to figure out this problem, but so far I have received as many different answers as people I have spoken with. Can we bill for the global on 76942, or are we forced to bill with the modifier 26 to medicare part B? Does anyone out there have any ideas where to look to find a definitive answer, CS at Medicare kept putting me on hold and still couldn't help.

  2. #2
    76942 Ultrasounic guidance for needle placement (eg, biopsy, aspiration, injection, localization device, imaging supervision and interpretation, has a the following ASC payment indicator for Medicare claims

    N1 packaged service/item; no separate payment made

    1. If the technical portion of the ultrasound guidance is considered packaged into the payment for the surgical procedure, it is unrealistic to expect the carrier to pay for the global with place service 24 because the equipment was provided.

    2. If you don't have 26 modifier on there, and you are billing for professional portion, they are going to deny it.

  3. #3
    Below are some reimbursement guides that go over pro/tech billing. Although the GE Ultrasound reimbursement gude states:

    TC-Technical Component
    This modifier would be used to bill for services by the owner
    of the equipment only to report the technical component of
    the service.

    There are limiations to that statement.

    "The Medicare Physician Fee Schedule does not recognize global billing in
    the facility setting..."

    Professional Services in a
    Facility Setting

    For services provided in a facility setting, including those to hospital
    inpatients and to hospital outpatients, the physician should bill only for the
    professional component by using modifier –26. There are several reasons
    for this, all related to statutes or Medicare coverage policy. In essence,
    only the hospital can provide the technical portion of a hospital service
    and a physician can provide only the professional portion of the diagnostic
    tests when they are provided in the facility setting. (Please see the section
    titled “Separate Reimbursement for Intraoperative Nerve Monitoring” for
    more information.)

    __________________________________________________ _________

    Hospital Outpatient or Ambulatory Surgery Center (ASC)
    If the site of service is a hospital (inpatient, outpatient or emergency department) or an ASC and the anesthesia provider is performing the ultrasound guidance, the –26 modifier
    (professional service only) should be appended to the CPT code for the imaging service.
    Based on the Medicare Outpatient Prospective Payment System (OPPS), beginning in 2008, the technical component of image guidance procedures that are performed in the hospital
    outpatient department or in the ASC are considered a packaged service. This means that the payment to the facility for these services is included in the payment for the primary procedure.

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