Billing > Facility Billing

When to use UB 04 or CMS 1500

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Jen99:
I am billing for a inpatient drug and alcohol rehab center.  They are not contracted with any insurance company.  However they want to bill PPO insurance companies and then balance bill the patient.  So do I use the UB 04 or the CMS 1500, or do I use both.  And if it is both what goes on what.  The paitents get and EEG done, they have appoinments with PYS and counselor's every day.

They also want to be able to provide a claim form for all patients so they can submit the claim themself.

PMRNC:
I'm assuming that means your office will not be filing ANY insurance claims?? If so you can send the patient an itemized bill, but you will need to separate facility/professional services so that they can submit the charges. The patient if they have out of network options have access to claim forms through their carrier.

Michele:
But if your facility wants to submit the claims as a courtesy it would be the UB04 form.

Jen99:
So all charges go on the UB 04 form?

If the provider bills 90801, 96101, 99403, 90818 it wouldn't go on the CMS 1500?   I thought because they are profesional services they would.

I have a pediatric private practice that goes to see the newborn's in the hospital and those visits go on a CMS 1500 even though the patient is inpatient.

I have to figure this billing out and give the claim form to the provider and I am lost.

These are all the codes they give me that they use.
99403
95957
96101
90818- this code is used multiple times a day (the patient will have 2 or 3 seperate sessions)
90901- this code is used 2 times a day as well
97124

Please guide me in how to bill them.

PMRNC:
Those do sound like the professional components and in which case would be CMS1500
Facility charges would go on UB

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