Neurology & Pain Management Coding Alert

Question: We need help billing the global services for 95920 and 95925. We pay a technician to operate our equipment, which we own, under the direct personal supervision of the surgeon. The Medicare fee schedule lists the global, technical component and professional component fees, but we can get paid only for the professional component. Should modifiers be used?

Washington Subscriber

Answer: Codes 95920 (intraoperative neurophysiology testing, per hour) and 95925 (short-latency somatosensory evoked potential study) refer to procedures with separately reimbursable technical and professional components. When reporting such codes without a modifier, you are indicating that the global fee (the professional and technical component combined) should be paid. Neurologists who render professional services such as supervision and interpretation of the test or study, but do not own the equipment or pay for the staff, append modifier -26 (professional component) when reporting these codes. Conversely, a facility that owns the equipment and pays the staff to operate the equipment but does not provide the professional services should report the same codes appended with modifier -TC (technical component) to be reimbursed for the cost of the equipment, overhead and technicians.

Even when the neurology practice owns and supplies the equipment and pays for the services of the technician, the facility where the operation is performed still has overhead costs (space, electric, etc.) and will therefore submit a claim for the technical component of the test or study. Therefore, when a carrier receives a claim for your services (95920 and 95925) with no modifier appended and a bill from the facility for the same services with modifier -TC, the carrier will automatically assume that you neglected to append modifier -26 and will reimburse only for the professional component.

Also, if you appeal the reduced payment on the basis that some portion of the technical fee is yours because you paid for the technicians services, your efforts are likely to be in vain because Medicare and most third-party payers consider the technical components of 95920 and 95925 to be services that cannot be billed by a physician.

To be reimbursed for your costs relating to the machines and the technicians, you should negotiate a rate and separately contract in advance with the facility where they will be used.