Wiki Facility fee denials for gastro procedures in our physician owned ASC

[Jenannurb]

I am hoping to get some input/advice..

We are being denied ALL of our facility fee charges for our ASC from Medicaid due to "Taxonomy codes not supporting our CPTs."
Our ASC is billing out with the taxonomy code for ambulatory surgery center, and a rep from Medicaid tells me that we should be using the taxonomy code for Gastroenterology.
We are managed by a large corporation, and they are insisting that the gastroenterology taxonomy code is not needed, and that I should be billing out with a TC and 26 modifier instead.

any input would be greatly appreciated!!!

 

[llhogeland]

Medicaid - ASC

We do not schedule our Medicaid patients for any procedures in our surgery center because Medicaid will not ever pay for the facility fees in an ASC. It has nothing to do with your taxonomy, it is a Medicaid rule, they only pay for procedures in a hospital setting. So we always schedule our Medicaid patients as outpatient hospital only. Feel free to private message me if you have any further questions.

 

[thomas7331]

Medicaid will not ever pay for the facility fees in an ASC. It has nothing to do with your taxonomy, it is a Medicaid rule, they only pay for procedures in a hospital setting.

This is not entirely accurate - Medicaid is governed differently in different states. Some state Medicaid programs do credential and pay ASC facilities. You'll need to examine your particular state's guidelines as to how these services should be billed.