I have had two outpatient surgery claims denied by a Medicare advantage plan as duplicate. We billed cpt code 15823 and the hospital billed the same cpt codes. When I called the claims department, I was told that we needed to check the way we were billing for a possible modifier needed and to check CMS website. Has anyone ever had heard of this? Since it is two different entities/NPI's and TAX ID numbers i wouldn't think there would be a problem
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Wiki Physician and Hospital billing same CPT code
- Thread starter colemanrl
- Start date
mitchellde
True Blue
Yes the hospital bills the same codes, but they should be using a UB type of billing with outpatient bill type, and your provider should be using the 1500 type of billing with a 22 POS. Check to be certain the facility did not include the provider services on the UB using the revenue code for physician. I worked with some facility billers that thought because that revenue code was available, they wear suppose yo use it.