Medicare & Payer-Specific Radiology Billing Flashcards
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Read the first 6 Medicare & Payer-Specific Radiology Billing flashcards as text
Medicare's facility fee schedule for outpatient radiology is governed by which system?
Answer: OPPS/APC
Outpatient hospital radiology services are paid under the Outpatient Prospective Payment System (OPPS) using Ambulatory Payment Classifications (APCs).
Which Medicare form is used to submit outpatient hospital radiology claims?
Answer: CMS-1450 (UB-04)
Outpatient hospital claims, including radiology, are submitted on the CMS-1450 (UB-04) claim form.
What is the Medicare global period for most radiology procedures?
Answer: 0 days (XXX indicator)
Most radiology procedures carry the 'XXX' global period indicator, meaning the concept of global period does not apply.
Medicare requires a written order for which imaging modality before services are rendered?
Answer: All advanced imaging under AUC program
The Appropriate Use Criteria (AUC) program requires ordering physicians to consult AUC for advanced diagnostic imaging including CT, MRI, and nuclear medicine.
Which modifier signals that a service was performed in a Medicare-approved Ambulatory Surgery Center?
Answer: Modifier SG
Modifier SG is used by ASCs to indicate the facility fee for services performed in that setting.
Under Medicare, which component of a radiology service is billed by the radiologist personally?
Answer: Professional component (Modifier 26)
Radiologists bill the professional component using Modifier 26, representing the physician's interpretation and report.