I am considering taking on a new client but I have a question. The provider is a non-physician owned IDTF (radiology). They have been billing in-house using POS code 11 because the radiologist is on-site. However, I feel that they should be using POS code 49. They disagree. its important because some of the insurance companies will pay allowable less a specialist copay for physician office but POS 49 will pay outpatient testing fee schedule. That makes it harder to get patients to schedule testing because it costs them more. Some of the insurance companies have caught onto this and process all claims correctly no matter what POS they indicate. However, some of the insurances still pay specialist benefits. So does having a radiologists onsite qualify for 11 POS code or is 49 correct?
