Wiki CPT 64493: Can I bill for facility fees on UB04?

[john.butora@outlook.com]

We are a pain management group and have been billing 64493-64495 with CMS-1500 claim form.
Can we also bill for facility charges since we are the ones who own the CT image guidance machine?

 

[thomas7331]

You can't bill facility fees just for owning equipment, you have to actually be licensed and credentialed as a facility.

If the practice is not a facility, then you're already getting a higher compensation for your services - by billing a POS code 11 for services performed in an office, you're reimbursed at the non-facility rate which includes your overhead costs, including costs for the office's equipment and supplies used in any procedures.

 

[sls314]

We are a pain management group and have been billing 64493-64495 with CMS-1500 claim form.
Can we also bill for facility charges since we are the ones who own the CT image guidance machine?

Does your practice have an ASC that is credentialed with Medicare and other health plans? Where are these services being provided?

 

[john.butora@outlook.com]

Does your practice have an ASC that is credentialed with Medicare and other health plans? Where are these services being provided?

You can't bill facility fees just for owning equipment, you have to actually be licensed and credentialed as a facility.

If the practice is not a facility, then you're already getting a higher compensation for your services - by billing a POS code 11 for services performed in an office, you're reimbursed at the non-facility rate which includes your overhead costs, including costs for the office's equipment and supplies used in any procedures.

No, we are not certified as an ASC center.
Thank you Thomas for your explanation. It was very helpful.