Services Furnished in Hospitals to Inpatients
Imaging services provided under arrangement are billed under Part A to
Medicare Fiscal Intermediaries (FIs) and A/B MACs, using revenue codes.
Payment for physician’s imaging services to the hospital, for example,
administrative or supervisory services, and for provider services needed
to produce the imaging service, ar made by the FI or A/B MAC to the
hospital as a provider service.
FIs and A/B MACs include the TC of imaging services for hospital
inpatients in the Inpatient Prospective Payment System (IPPS) payment to
hospitals, except that payment to Critial Access Hospitals (CAHs) for
inpatients is made at 101 percent of reasonable cost. Carriers may not
pay for the TC of imaging services furnished to hospital patients.
The PC of imaging services performed by physicians for hospital
inpatients may be separately billed by the physician and paid by the
carrier or A/B MAC.
Services Furnished in Hospitals to Outpatients
Imaging services provided either directly or under arrangement are
billed under Part B to Medicare FIs and A/B MACs, using revenue codes,
HCPCS code, line item dates of service, units, and applicable HCPCS
modifiers. Charges must be reported by HCPCS code.
Imaging services furnished to hospital outpatients are paid under the
Outpatient Prospective Payment System (OPPS) to the hospital, except
that payment to CAHs for outpatients is made at 101 percent of
reasonable cost.
Mammograms furnished to inpatients or outpatients are paid under the MPFS to the hospital.
The PC of imaging services performed by physicians for hospital
outpatients may be separately billed by the physician and paid by the
local carrier or A/B MAC.
Services Furnished in Method II CAH Hospitals
In addition to the TC mentioned above, the PC of imaging services are
billed under Part B to Medicare FIs and A/B MACs, using revenue codes
series 0960 thru 0989, HCPCS code, line item date of service, units, and
applicable HCPCS modifiers. Charges must be reported by HCPCS code.
The PC of imaging services furnished to CAH patients is made at 115 percent of the MPFS.
Services Furnished in Skilled Nursing Facilities (SNF)
Payment for a SNF bill for imaging services furnished to its residents
in a Part A covered stay is include in the SNF Prospective Payment
System. However, certain types of ADI, such as MRI and CT, are
separately payable under Part B when performed in the outpatient
hospital setting.
Imaging services furnished on an ambulatory basis to residents of SMFs
may be billed by the supplier performing he service or by the SNF under
arrangements with the supplier.
The PC of imaging services performed by physicians for SNF residents, on
either an inpatient or ambulatory basis, may be separately billed and
paid.
Mammograms furnished to SNF residents are paid under the MPFS to the SNF.
Services Furnished by Rural Health Clinics (RHC) and Federally Qualified Health Centers (FQHC)
Independent and provider-based RHCs and FQHCs bill for the PC using
revenue codes 52x. RHCs are not required to submit HCPCS codes for
imaging services. However, FQ?HCs are required to submit HCPCS codes.
The TC is outside the scope of the RHC/FQHC benefit. Technical
services/components associated with professional services/components
performed by independent RHCs or FQHC are billed to the carrier and A/B
MAC.
Technical services/components associated with professional
services/components performed by provider-based RHCs or FQHCs are billed
to the FI and A/B MAC on the base-provider type of bill.
