Saturday, October 30, 2010

NDC on ub 04 - where to report

Placement of an NDC when filing a claim:

Paper:

If billing on a paper claim, an original Red & White form must be used - not a copy of an original.

 UB-04 location – Box 43 (Please refer to the NUBC for additional guidelines)




 CMS 1500 location – Box 24A (shaded area) (Please refer to NUCC for additional guidelines)


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Medicare physician fee schedule - Quick overview

Medicare Part B pays for physician services based on the PFS, which lists the more than 7,400 unique
covered services and their payment rates. Physicians’ services include the following:

* Office visits;
* Surgical procedures;
* Anesthesia services; and
* A range of other diagnostic and therapeutic services.


Medicare Physician Fee Schedule Payment Rates

Payment rates for an individual service are based on
three components:
1) Relative Value Units (RVU)
2) Conversion Factor (CF)
3) Geographic Practice Cost Indices (GPCI)


Medicare Physician Fee Schedule Payment Rates Formula


The Medicare PFS payment rates formula is shown below:

[(Work RVU x Work GPCI) + (PE RVU x PE GPCI) +
(MP RVU x MP GPCI)] x CF

Medicare fee schedule download