Wiki Coding X-ray

[JLara99]

My provider's x-ray machine is broke therefore we are sending patients to another facility to have x-rays performed and they are bringing the x-rays back to have them read by my provider. If the facility is charging my provider instead of billing the insurance directly, can we bill the insurance for the x-ray or are we only allowed to bill for the reading?

Thank you!

 

[thomas7331]

You can bill for these services that your practice has purchased, but there are some rules that you'll need to follow - in particular, under CMS anti-markup rules, you cannot bill for more than the amount that you paid, and you are required to identify the provider that performed the services on your claim. You can find more detail on this in the Medicare manual, chapter 13, see section 20.3 here: https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/Downloads/clm104c13.pdf

 

[JLara99]

Thank you Thomas!