Wiki Critical Access EM Billing for Profee and Facility Charges

raymondcb

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I have a question about EM billing for profee and facility fees together. At my facility (which is critical access), the physicians charge the profee component and the facility fee under the same NPI, as there is no separate physician group. There is a question as to whether the facility fee needs a 27 modifier in addition to the 25 modifier. This would apply to our ED visits and clinic visits. Does anyone have any insight about this type of scenario? Our team is unsure if the 27 modifier is appropriate to use since these profee and facility charges are 2 components of the same visit and not truly separately identifiable visits. I'd appreciate any help, thank you!
 
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