It is essential to verify each payer’s specific payment and coverage policy for APPs. The services are submitted/billed under the name of the APP or under the name of the physician depending on payer policy. Nearly all payers, including Medicare and Medicaid, cover medical and surgical services provided by APPs, in accordance with state law. It is essential to verify each payer’s specific payment and coverage policy through the payer or the local CMS representative. The CPT code and the modifier that most accurately describes the ultrasound exam/procedure performed should be included in the documentation. Diagnostic and procedural ultrasound performed by PA/NPs should be coded and reimbursed in the same manner as any other procedure which is performed in the course of the patient’s care, using Current Procedure Terminology (CPT) codes. 2Īlthough billing for diagnostic and procedural ultrasound is rather straightforward, SPOCUS frequently encounters questions regarding advanced practice provider (APP) billing. 1 The use of clinical ultrasound is sufficiently developed that it can be considered essential to good patient care in diagnosing, monitoring and treating a wide variety of conditions, and should be billed as a separate billable procedure. Clinical ultrasound is a separate entity, that is distinct from the physical examination and adds anatomic, functional, and physiologic information to the care of the acutely-ill patient.
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