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Thread: Hospital Charging 99201 as a Facility Charge?

  1. #11


    AAPC: Back to School
    I guess I should have clarified better...the physicians that I code for are employed by the hospital (just like the ED physicians) as is the rest of the staff..they do not rent from the hospital...the hospital ownes and operates all of the clinics that I code for. Another thing I should have clarified is that not all payors recognize Provider Based. Medicare, Medicaid and Medical Assistance are the main ones that DO recognize billing as a Provider Based clinic. Maybe each state is different, that I'm not sure of. Provider Based Billing is completely legitimate and is widely used.

  2. #12
    Join Date
    Apr 2007
    Milwaukee WI

    Default Facility Charge

    Our hospital based providers "rent" space in hospital owned clinics / office buildings.

    The hospital hires the nurses, lab techs, xray techs, etc, owns all the equipment, and provides virtually all the supplies.

    The physician bills ONLY for the professional component of his services. The hospital (facility) bills for the facility charge, which is based on the nursing time and equiment/supplies used. They use either new patient or established patient codes, as they are not allowed to use consultation codes.

    It's entirely possible (and in fact, likely), that a physician seeing a patient for a consultation might have spent 45 minutes and coded a 99244 visit, while the hospital facility charge is based on the nursing time of only 10 minutes and equates to a 99201.

    The physician is reimbursed at a lower rate because he is in a facility. The hospital is reimbursed for their costs associated with nursing.

    Even if the patient is in a global surgical post-op period for the physician follow-up visit (no charge by MD CPT 99024), the facility still charges for the nursing time and use of any supplies/equipment (e.g. re-casting for fractures).

    F Tessa Bartels

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