Monday, October 18, 2010

Billing PROCEDURE CODE Q0092, R0070, R0075

Set-Up Component (HCPCS Code Q0092)

Carriers must pay a set-up component for each radiologic procedure (other than retakes of the same procedure) during both single patient and multiple patient trips under Level II HCPCS code Q0092. Carriers do not make the set-up payment for EKG services furnished by the portable x-ray supplier.

Transportation of Equipment Billed by a SNF to an FI

When a SNF bills for portable x-ray equipment transported to a site by van or other vehicle, the SNF should bill for the transportation costs using one of the following HCPCS codes along with the appropriate revenue code:

R0070 Transportation of Portable x-ray Equipment and Personnel to Home or Nursing Home, Per Trip to Facility or Location, One Patient Seen.

R0075  Transportation of Portable x-ray Equipment and Personnel to Home or Nursing Home, Per Trip to Facility or Location, More than One Patient Seen, Per Patient.

These HCPCS codes are subject to the fee schedule.

Effective April 1, 2006, SNFs are required to report the appropriate modifiers to identify the number of patients served when billing for R0075. See section 90.3, of this chapter for the list of modifiers used to identify on the claim the number of patients served.

Fiscal intermediaries shall ensure that payment for R0075 is consistent with the definition of the modifiers.

Modifiers for Transportation of Portable X-rays (R0075) 

Policy: Medicare allows a single transportation payment for each trip the portable x-ray supplier makes to a particular location. Some contractors currently use the units field of the Medicare claim form to prorate the services to determine the appropriate single payment. This results in inconsistencies in reporting of these services among providers and contractors, and inflates the national frequency data based on the units field for these services. Therefore, effective upon implementation of this document, the five (5) new modifiers previously implemented for R0075 in CR 2856, Transmittal 14, shall be used to report the number of patients served during a single trip. These modifiers are listed below. NOTE: If only one patient is served, R0070 should be reported with no modifier since the descriptor for this code reflects only one patient seen.

UN Two patients served
UP Three patients served
UQ Four patients served
UR Five patients served
US Six patients or more served

Payment for the above modifiers must be consistent with the definition of the modifiers. Therefore, for R0075 reported with modifiers, -UN, -UP, -UQ, and –UR, the total payment for the service shall be divided by 2, 3, 4, and 5 respectively. For modifier –US, the total payment for the service shall be divided by 6 regardless of the number of patients served. For example, if 8 patients were served, R0075 would be reported with modifier –US and the total payment for this service would be divided by 6.

The units field for R0075 shall always be reported as “1” except in extremely unusual cases. The number in the units field should be completed in accordance with the provisions of 100-04, chapter 23, section 10.2 item 24 G which defines the units field as the number of times the patient has received the itemized service during the dates listed in the from/to field. The units field must never be used to report the number of patients served during a single trip. Specifically, the units field must reflect the number of services that the specific beneficiary received, not the number of services received by other beneficiaries.

R0075 must be billed in conjunction with the procedure  radiology codes (70000 series) and only when the x-ray equipment used was actually transported to the location where the x-ray was taken. R0075 would not apply to the x-ray equipment stored in the location where the x-ray was done (e.g., a nursing home) for use as needed.

Determining Payment for Multiple Patients Served

Medicare will make payment for the modifiers based on the definition of the modifier. The payment for serving a single patient (R0070) will be used as the base rate for R0075 (more than one patient seen), and will be prorated for the number of patients served. For example:

• If R0075 is reported with modifiers UN, UP, UQ, and UR, the total payment for a single patient served will be divided by the 2, 3, 4, and 5 respectively.

• If R0075 is reported with modifier US, the total payment for a single patient served will be divided by 6 regardless of the number of patients served. For example, if eight patients were served, R0075 would be reported with modifier US, and the total payment for a single patient for this service would be divided by 6.

The units field for R0075 will almost always be reported as “1.” The number in the units field indicates the number of times the patient received the itemized services on the “line item date of service” specified on the same line.

The units field must reflect the number of services received by a specific beneficiary only, not the number of services received by other beneficiaries. The unit field must never be used to report the number of patients served during a single trip.

HCPCS code R0075 must be billed with the Current Procedural Terminology  radiology codes (7000 series) and only when the x-ray equipment used was actually transported to the location where the x-ray was taken. R0075 should not be billed for the use of x-ray equipment that is stored in the location where the xray is done (e.g., a nursing home) for use as needed.

Please be aware that Medicare will return to the provider claims containing R0075 when billed without one of the five modifiers. 

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