Tuesday, June 29, 2010

Coverage and Reimbursement for Fluoroscopy

Coverage and Reimbursement for Fluoroscopy


Currently, Medicare does not have a national coverage policy that addresses fluoroscopy for pain
management procedures. Coverage of these procedures is at the discretion of local Medicare
contractors who process claims on behalf of the Medicare program. Providers should ascertain
coverage for the pain management procedure in addition to coverage for fluoroscopy itself.


Medicare reimbursement for fluoroscopic guidance is comprised of a professional component,
the amount paid for the physician’s service, and a technical component, the amount paid for all
other services (including staffing and equipment costs). When these components are combined and paid to the same individual or entity, this is often referred to as the total or global
Currently, Medicare reimburses fluoroscopic guidance differently depending on the site of care.
The technical component of the procedure performed in a physician’s office or IDTF is
reimbursed under the Medicare physician fee schedule. In a hospital outpatient department,
the technical component of a procedure is reimbursed under an Ambulatory Payment
Classification (APC) under Medicare’s hospital outpatient department prospective payment
system (HOPPS). In a hospital inpatient site of care, the technical (facility) payment is
subsumed within the payment to the hospital that is determined based on the Diagnosis Related
Group (DRG) to which the patient is assigned. The professional component is reimbursed under
the Medicare physician fee schedule regardless of setting.
In the case of a Medicare certified ambulatory surgical center (ASC), please note that the
technical component of fluoroscopy is not separately payable. However, when an ASC and
IDTF share space (but do not operate at the same time in that space), CMS and its local carriers
generally allow the IDTF to bill and be paid for by the program for the technical component of
fluoroscopy if it is reasonable and necessary, directly related to the performance of a surgical
procedure and furnished in conjunction with a surgical procedure during the ASC’s designated
hours.10 However, the ASC should consult with the local Medicare carriers regarding this issue
before submitting an IDTF enrollment application.

Table 3 provides information concerning Medicare national payment rates for fluoroscopy
imaging guidance performed in the hospital inpatient, hospital outpatient, IDTF and physician
office sites of service. It is important to note that, in the hospital outpatient site of care, the
fluoroscopy procedures are not reimbursed separately, but rather are “packaged” or included in
the APC payment to the hospital. For more information about reimbursement of these
procedures in your area, consult your local Medicare contractor.


  1. I have a number of questions pertaining to billing for Fluoroscopic. Please contact me directly. (678) 243-0581 Thanks David

  2. i am an in office physician. what they pay me now for in office facets does not cover the cost of the fluoroscopy and even if they paid me for the technical component it would not cover the expenses. However my billers are confused and not biling for the technical component.

    We use a surgery centers carm to do our procedurres. the surgery center does not bill for the fluoroscopy (77003) or bill for a facility fee. we bill as site 11. how do we get paid for the fluoroscopy?? the codes are 64493,64494,64495,64490,64491,64492,64493, 64479,64480,64483,64484 for facets and transforaminal epidurals. they do not reimburse the physician for the carm. we need to get paid for the carm and supplies which are reimbursed to an asc or hospital at site 22 (facility). How do we get paid as the office for the supplies? this is all rhetoric so no one can figure it out.

    dr w 9722766300 call me or email me at ssopbusiness@yahoo.com

    thank you



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