Payment for Ultrasound Screening for Abdominal Aortic Aneurysm (Rev. 1113, 01-02-07)

by  Jared Staheli
July 6th, 2015

If the screening is provided in a physician office, the service is billed to the carrier using the HCPCS code identified in section 110.3.2 below. Payment is under the Medicare Physicians Fee Schedule (MPFS).

Fiscal Intermediaries (FIs) shall pay for the AAA screening only when the services are performed in a hospital, including a critical access hospital (CAH), Indian Health Service (IHS) Facility, Skilled Nursing Facility (SNF), Rural Health Clinic (RHC), or Federally Qualified Health Center (FQHC) and submitted on one of the following types of bills (TOBs): 12X, 13X, 22X, 23X, 71X, 73X, 85X.

The following describes the payment methodology for AAA Screening:

Facility Type of Bill Payment
Hospitals subject to OPPS 12X, 13X OPPS
Method I and Method II Critical Access Hospitals (CAHs) 12X and 85X 101% of reasonable cost
IHS providers 13X, revenue code 051X OMB-approved outpatient per visit all inclusive rate (AIR)
IHS providers 12X, revenue code 024X All-inclusive inpatient ancillary per diem rate
IHS CAHs 85X, revenue code 051X 101% of the all-inclusive facility specific per visit rate
IHS CAHs 12X, revenue code 024X 101% of the all-inclusive facility specific per diem rate
SNFs ** 22X, 23X Non-facility rate on the MPFS
RHCs* 71X, revenue code 052X All-inclusive encounter rate
FQHCs* 73X, revenue code 052X All-inclusive encounter rate
Maryland Hospitals under jurisdiction of the Health Services Cost Review Commission (HSCRC) 12X, 13X 94% of provider submitted charges or according to the terms of the Maryland Waiver

* If the screening is provided in an RHC or FQHC, the professional portion of the service is billed to the FI using TOBs 71X and 73X, respectively, and the appropriate site of service revenue code in the 052X revenue code series.

If the screening is provided in an independent RHC or freestanding FQHC, the technical component of the service can be billed by the practitioner to the carrier under the practitioner’s ID following instructions for submitting practitioner claims to the Medicare carrier.

If the screening is provided in a provider-based RHC/FQHC, the technical component of the service can be billed by the base provider to the FI under the base provider’s ID, following instructions for submitting claims to the FI from the base provider.

** The SNF consolidated billing provision allows separate part B payment for screening services for beneficiaries that are in skilled Part A SNF stays, however, the SNF must submit these services on a 22X bill type. Screening services provided by other provider types must be reimbursed by the SNF.

References:

Payment for Ultrasound Screening for Abdominal Aortic Aneurysm (Rev. 1113, 01-02-07). (2015, July 6). Find-A-Code Articles. Retrieved from https://www.findacode.com/articles/payment-for-ultrasound-screening-for-abdominal-aortic-aneurysm-rev-1113-01-02-07-27028.html

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