Wednesday, July 28, 2010

ASC BILLING Type of service

Medicare Billing Process

A provider number is applied for by the ASC and issued by the Medicare carrier after approval from the State and the regional CMS carrier.  This supplier number is applied for under the ASC Tax ID. Claims cannot be billed to Medicare for facility fees until the provider number is given by CMS regional and the actual billing number assigned by the carrier.  The effective date is the date of survey compliance.

Once approval is received, facility fees are billed to Medicare on the standard HCFA 1500 form using the CPT code with the modifier –SG.  Place of service is 24 (ASC)

Type of Service

Surgical services billed with the ASC facility service modifier SG must be
reported as TOS F. The indicator F does not appear on the TOS table because its
use is dependent upon the use of the SG modifier.

On the HCFA 1500 list:
•    CPT Code + SG modifier
•    List highest group first
•    Use -59 as applicable based on LMRP for multiple procedures or additional levels of the same procedure
•    Bilaterals  - Use –50 (units 1) or RT/LT by line  (increase fee x 2)

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