Wiki New to ASC Billing

[LORA CRAWFORD]

I am new to ASC billing and need a bit of guidance. I am in AZ and have been told that the AHCCCS claims are required to be billed on a UB-04.(?) I also read in a Medicare publication that each procedure gets a modifier of SG. Is that always the first modifier? Any bit of assistance would be helpful. Lora

 

[mbort]

Hi Lisa,

Welcome the the ASC world!! Claims should be billed on the UB92 (could be called the UB04 now???) Medicare did away with the SG modifier as of 1-1-08however you may find that some payors will still require it (DOL, Tricare, ect). I dont know of any commercial payors that require it but could be possible. That will be trial and error.

Hope this helps.

Good Luck
Mary

 

[elenax]

I bill most of my claim on UB-04; Medicare, Worker's Comp and Auto I bill on the cms1500 but you can also bill these on UB-04 if you have all the required information. The Modifier SG is invalid for 2008; prior to that year it was required.

hope this helps!

 

[mbort]

Sorry..I also bill my Medicare claims on a CMS 1500, there are a few W/C carriers (DOL) that use the 1500 as well as Tricare.

 

[gared111]

I am new to ASC billing and need a bit of guidance. I am in AZ and have been told that the AHCCCS claims are required to be billed on a UB-04.(?) I also read in a Medicare publication that each procedure gets a modifier of SG. Is that always the first modifier? Any bit of assistance would be helpful. Lora

Medicare dropped the SG modifier for 2008 as already stated but I use it as the first modifier for almost every other payer. There of course are exceptions to that such as radiology where you would use just a TC modifier (assuming you're just billing the technical component in an ASC...use 26 if your billing for the physician side of it). As for Tricare I bill that on a UB (with full signature!) & have never been asked to resubmit on a CMS1500 . Washington state Medicaid doesn't use the SG modifier but if billing for multiple procedures they ask you to use U1 for the first procedure U2 for the 2nd & so on.

Medicare & workers comp still require the CMS1500 for ASC's but I use the UB for most other payers.