Centralized Billing For Influenza Virus & Pneumococcal Vaccines

Centralized billing is a process in which a provider, who provides mass immunization services for influenza virus and pneumococcal pneumonia virus (PPV) immunizations, can send all claims to a single contractor for payment regardless of the geographic locality in which the vaccination was administered. (This does not include claims for the Railroad Retirement Board, United…

Hospital Billing Setup Explained

Hospitals This page provides basic information about being certified as a Medicare and/or Medicaid hospital provider and includes links to applicable laws, regulations, and compliance information.A hospital is an institution primarily engaged in providing, by or under the supervision of physicians, inpatient diagnostic and therapeutic services or rehabilitation services. Critical access hospitals are certified under…

Guidelines For CPT 97813, CPT 97814 & CPT S8930 | Cranial Clectrotherapy Stimulation (CES)

Guidelines For CPT 97813, CPT 97814 & CPT S8930 | Cranial Clectrotherapy Stimulation (CES)

Coding  Code Description CPT 97813 Acupuncture, 1 or more needles; with electrical stimulation, initial 15 minutes of personal one-on-one contact with the patient 97814 Acupuncture, 1 or more needles; with electrical stimulation, each additional 15 minutes of personal one-on-one contact with the patient, with re-insertion of needle(s) (List separately in addition to code for primary…

Documentation For Modifier 24

Based on widespread probes of office evaluation and management (E/M) services, First Coast has discovered that the 24 modifier for E/M services, when billing within a global surgery period, has been billed incorrectly at least 60 percent of the time. Clinical review of documentation demonstrates that modifier 24 was either not supported for the encounter,…

Immune Globulin Injection CPT Codes

CPT/HCPCS Codes Group 1 Codes: J1459INJECTION, IMMUNE GLOBULIN (PRIVIGEN), INTRAVENOUS, NON-LYOPHILIZED (E.G., LIQUID), 500 MG J1556INJECTION, IMMUNE GLOBULIN (BIVIGAM), 500 MG J1557INJECTION, IMMUNE GLOBULIN, (GAMMAPLEX), INTRAVENOUS, NON-LYOPHILIZED (E.G., LIQUID), 500 MG J1561INJECTION, IMMUNE GLOBULIN, (GAMUNEX-C/GAMMAKED), NON-LYOPHILIZED (E.G., LIQUID), 500 MG J1566INJECTION, IMMUNE GLOBULIN, INTRAVENOUS, LYOPHILIZED (E.G., POWDER), NOT OTHERWISE SPECIFIED, 500 MG J1568INJECTION, IMMUNE GLOBULIN,…

Proper Billing Of Outpatient Drugs

Medicare uses an outpatient prospective payment system (OPPS) to pay certain outpatient claims. With this method of reimbursement, the Medicare payment is not based on the amount the provider charges; therefore, the billed charges generally do not affect the current Medicare prospective payment amounts. Billed charges usually exceed the Medicare payment amount; therefore, a Medicare…

CPT Code Flow Cytometry

Coverage Indications, Limitations, and/or Medical Necessity Flow cytometry (FCM) is a complex process to examine blood, body fluids, CSF, bone marrow, lymph node, tonsil, spleen and other solid tissues. The use of peripheral blood and fine needle aspirate material avoids more invasive procedures for diagnosis. A flow cytometer evaluates the physical and/or chemical characteristics of…

How to submit a claim for Co surgeons and Team surgeons – Full guide with example

A. General Under some circumstances, the individual skills of two or more surgeons are required to perform surgery on the same patient during the same operative session. This may be required because of the complex nature of the procedure(s) and/or the patient’s condition. In these cases, the additional physicians are not acting as assistants-at-surgery. B….

CPT j0885 – ESA | Erythropietin Stimulating Agent

CPT/HCPCS Codes Group 1 Codes: J0881INJECTION, DARBEPOETIN ALFA, 1 MICROGRAM (NON-ESRD USE) J0882INJECTION, DARBEPOETIN ALFA, 1 MICROGRAM (FOR ESRD ON DIALYSIS) J0885INJECTION, EPOETIN ALFA, (FOR NON-ESRD USE), 1000 UNITS Q4081INJECTION, EPOETIN ALFA, 100 UNITS (FOR ESRD ON DIALYSIS) Coverage Indications, Limitations, and/or Medical Necessity An erythropoietin stimulating agent (ESA) is an analog of erythropoietin. ESAs…

Prior Authorization Initiatives

Repetitive Scheduled Non-Emergent Ambulance Transport The Centers for Medicare and Medicaid Services (CMS) will implement a 3 year prior authorization program for repetitive scheduled non-emergent ambulance transports in the states of New Jersey, Pennsylvania, and South Carolina based on where the ambulance company is garaged. A repetitive ambulance service is defined as medically necessary ambulance…