Question:
Can we charge an E/M service when we do a scheduled endoscopy to account for the cost of nursing staff, supplies, pre- and post- care of the patient in the suite? We use place of service office, and I know we can’t charge a facility fee. Many of our commercial payers pay the same professional fee, whether we do the service in our office or in the outpatient department.
Answer:
You cannot charge a separate E/M for doing a procedure in your office to cover the costs of the supplies, staffing, etc.
For Medicare, professional fees for CPT® codes are valued with facility and non-facility values. The non-facility payment is higher than the facility fee. A physician gets paid more for a service done in the office than for the same CPT® code/service done in a facility, to account for the additional costs. I’m sorry to hear your private payers don’t provide a differential payment, as well.
Here is a brief explanation of facility versus non-facility payments. This article provides a little more detail about RVUs.
And, if you search for modifier 25 in the search box, you will find resources about the requirements for that modifier.
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