Billing > Facility Billing

Use of CPT codes for facility fees

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dress:
2 billing statements - same doctor - LT Clavicle surgery - charge approx $19,300k - Receive identical codes on billing for surgery center for $ 19, 800 - no use of revenue codes at all and I'm told its facility fees.  Can a biller use CPT codes for facility fees?  How does a patient know what they are paying for re facility fees if the charge is coded as a medical procedure? I.E. - CPT codes?

Confused......comments welcome...An APC code was also used and the patient receives no federal benefits, medicare, etc.  Help please... thanks in advance!

K

Michele:
Facility fees are billed using rev codes on a UB04 form. Surgerical fees are billed with CPT codes on CMS forms.

tlewis:
Freestanding ASC are billed on cms-1500 forms and are billed using procedure codes.

midwifebiller:
Some insurance carriers require ASC claims on a CMS-1500 form, others require ASC claims on a UB-04 form.  And yet other carriers will accept ASC claims on either form. 

We do quite a bit of explaining over the phone when a patient calls and asks why they were billed for a 59400 plus a 59400-SG.

Nancyo2:
Would anyone know the description for Modifier SU? Thanks for your help, Nancy O.

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