by Jared Staheli
July 6th, 2015
Contractors will pay for IPPE or EKG only when the services are submitted on one of the following TOBs: 12X, 13X, 22X, 71X, 73X and 85X.
Type of facility and setting determines the basis of payment:
• For the IPPE or the screening EKG tracing only performed on a 12X and 13X TOB, hospital inpatient Part B and hospital outpatient, for hospitals subject to the outpatient prospective payment system (OPPS), under the OPPS. Hospitals not subject to OPPS shall be paid under current methodologies.
• For services performed on an 85X TOB, Critical Access Hospitals (CAHs), pay on reasonable cost.
• For services performed in a skilled nursing facility, TOB 22x, make payment for the technical component of the EKG based on the MPFS.
• For inpatient or outpatient services in hospitals in Maryland, make payment according to the Health Services Cost Review Commission.
• For services performed on a 12X TOB, Indian Health Services (IHS) hospitals, payment is made based on an all-inclusive ancillary per diem rate.
• For services performed on a 13X TOB, IHS hospitals, payment is made based on the all-inclusive rate (AIR).
• For services performed on an 85X TOB, IHS CAHs, payment is made based on an all-inclusive facility specific per visit rate.
All CAHs are paid for the technical or facility component of the IPPE itself. They are also paid for the technical component of the EKG, the tracing only, if the EKG is performed. Only CAHs paid under the optional method are paid for the professional component of the IPPE itself (in addition to the facility payment) for charges under revenue code 0960. If the EKG is performed, CAHs paid under the optional method may also be paid for the interpretation of the EKG (in addition to the payment for the tracing) when billed under revenue codes 0985 or 0986.