Wednesday, August 11, 2010

Radiology Services under ASC - Electronic loop setup

Payment for Radiology Services

Medicare will pay separately for certain radiology services that are provided integral to covered surgical procedures in ASCs. For radiology services to be considered an integral part and to be considered separate, these services must be provided:

• Immediately before surgery.
• During surgery.
• After a covered surgical procedure.

Payment for ancillary radiology services is made to ASCs at the lesser of the ASC rate or the amount of the non-facility practice expense under the MPFS. The ASC may receive separate payment for the technical component of the covered ancillary radiology procedure.

Modifier TC will indicate that the ASC facility is billing for the technical component of the radiology service.
Radiology services that have a PC/TC indicator on the MPFS database must be submitted with the TC modifier to indicate payment for the technical component of the procedure.

Effective January 1, 2009, the ordering/referring physician must be reported on claims for diagnostic services submitted by ASCs. This information should be reported in Items 17 and 17b or the electronic equivalent.

Loop 2310A or 2420F/NM103 (DN) Referring Provider Last Name
Loop 2310A or 2420F/NM104 (DN) Referring Provider First Name
Loop 2310A or 2420F/NM105 (DN) Referring Provider Middle Name
Loop 2420E/NM103 Ordering Provider Last Name
Loop 2420E/NM104 Ordering Provider First Name
Loop 2420E/NM105 Ordering Provider Middle Name

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