Outpatient Facility Coding Alert - 2016 Issue 2
Reader Question: Verify Breast Biopsy Procedure Location
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Article Overview
This reader Q&A addresses a Medicare billing question involving a breast biopsy service and whether it is reported as a professional and technical split. It is aimed at coders and billing staff who work with breast imaging procedures, physician fee schedule payment concepts, and facility versus non-facility settings. The article provides general guidance on how the service is classified for payment purposes and notes setting-based reimbursement differences.
Why This Topic Matters
Understanding how a breast biopsy service is classified under the Medicare Physician Fee Schedule helps practices and facilities report the service consistently and recognize how payment varies by place of service.
What You Will Learn
- How a breast biopsy service is categorized under Medicare payment methodology
- Why place of service can affect reimbursement for the procedure
- How facility and non-facility settings are discussed in relation to billing for the service
- What types of payment concepts are relevant to physician fee schedule reporting
Who Should Read This
- Medical coders
- Billing specialists
- Physician practice managers
- Radiology billing staff
- Breast imaging staff
Codes Discussed
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