Author Topic: Pain MGMT - Office procedure  (Read 1310 times)

prhodes

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Pain MGMT - Office procedure
« on: December 02, 2014, 01:37:36 PM »
We are Pain Mgmt -   -- preform office surgical procedures - Can  they charge facility  fee if  - done in office  POS 11 ?   What CPT Code is used for Facility  Fee?

Thank You

Merry

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Re: Pain MGMT - Office procedure
« Reply #1 on: December 02, 2014, 03:09:41 PM »
If POS is 11 then you cannot charge a a facility fee




RichardP

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Re: Pain MGMT - Office procedure
« Reply #2 on: December 02, 2014, 08:14:01 PM »
What CPT Code is used for Facility Fee?

It might help if you think in terms of "office fee" and "facility fee".  Office fees are what the doctor submits for payment when the service is performed in his office.  Facility fees are what the doctor submits for payment when the service is performed in some facility other than his office.

The distinction between office fees and facility fees is based on the overhead the doctor has to pay for when he performs services in his own office.  When he performs services in some other facility, that doctor has not incurred overhead charges.  Therefore, the facility fee payment is usually less than the office fee payment.

There is not a paticular "Facility Fee" CPT Code.  The payor knows what amount to pay on a given CPT Code based on the POS # connected to the CPT Code on the CMS 1500 Form.  The pdf file at this link might help you visualize this better:

http://www.hillscountyhealth.org/absolutenm/articlefiles/74-2013-2014%20CPT%20Code%20Listing.pdf

Here is a link to POS Codes:

http://www.cms.gov/Medicare/Coding/place-of-service-codes/Place_of_Service_Code_Set.html

Any POS Code other than 11 has the potential to trigger a reduced payment to the doctor because he does not have to pay the overhead cost associated with that particular service location.  Note though that, if the doctor IS paying overhead at this other location, then it qualifies to be called his office, and POS Code 11 should be used.