Tuesday, July 6, 2010

Radiology billing method

Billing Method Guidelines

Radiology Procedure-4 procedure codes 70010 – 78816, 78999 – 79445   and 79999 are billed by different methods.  Although the method used depends on the contractual or other type of mutual agreement between the facility and the physician, and applies to both inpatient and outpatient services, the principal determinants are the provisions of the contract that the facility has with the Medi-Cal program.  Facilities that are not under contract to Medi-Cal may make an arrangement with the physician that is mutually agreeable within these policy guidelines.



The Department of Health Care Services (DHCS) has defined the billing method options as follows:

Split-Billable

Split-billable services:  These codes are separately reimbursable by different providers for the professional and technical component.  The facility and physician each bill for their respective component of the service with modifiers 26, TC or ZS.

    Full-Fee Billing – Physician bills for both the professional and technical components and subsequently reimburses the facility for the technical component according to their mutual agreements.
    Standard Billing – Facility bills for both the technical and professional components and reimburses the physician for the professional component according to their mutual agreements.



Not Split-Billable

Services that are not split-billable:  These codes are not separately reimbursable by different providers for the professional nor technical component.  Only one provider may be reimbursed for these codes.  These codes must not be submitted with modifiers 26, TC nor ZS.


Billing Total Service and/or  View(s) Codes

Complete view and separate view radiology services codes are not separately reimbursable for the same recipient, same provider and same date of service.

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