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76937 & 76942 In Hospital Setting

  1. #1
    Question 76937 & 76942 In Hospital Setting
    Medical Coding Books
    As an anesthesia group, we use 76937 & 76942 for vascular access and needle placement. We own our ultrasound machine. In the hospital setting, Medicare will not pay for the technical and professional components together for 76937 & 76942 stating denial as invalid place of service when done in the hospital. Would it be appropriate to still bill these two codes with a modifier 26 to at least get reimbursed for the professional component portion that our doctors are doing even though we own the ultrasound equipment? Any advice regarding this will be greatly appreciated. Thank you!

  2. #2
    Frederick, MD
    We apply the 26 modifier to 76937 and 76942 when billing for these services at the hospital.

  3. #3
    Even if you own the ultrasound machine, is it OK to just bill the 26?

  4. #4
    Hospital billing – Medicare Part B carriers may not pay for the technical component (TC) of radiology services furnished to hospital patients. Payment for physicians' radiological services to the hospital is made by the fiscal intermediary (FI) as a provider of service.

    Global Billing in an office setting - PC and TC services furnished in a physician's office, a freestanding imaging or radiation oncology center, or leased hospital radiology department, or other setting that is not part of a hospital are paid by the Medicare Part B carriers under the Medicare Physician's fee schedule. These services may be billed globally, or by the components.


    PC/26 – The professional component is the interpretation of the results of the test. When the professional component is reported separately the service may be identified by adding modifier 26.

    The interpretation of the image/result would be a billable service for the component of the professional service in the scenario you are describing.

  5. #5
    Your response is greatly appreciated and helpful. Thank you!

  6. Question cpt 76937
    If a CRNA places the CVP line and uses the U/S. Can the CPT 76937 be billed under the CRNA?

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