RCC Medicare & Payer-Specific Radiology Billing 1 — Questions and Answers
Question 1: Medicare's facility fee schedule for outpatient radiology is governed by which system?
- OPPS/APC (Correct answer)
- RBRVS/MPFS
- DRG/IPPS
- TRICARE fee schedule
Correct answer: OPPS/APC
Outpatient hospital radiology services are paid under the Outpatient Prospective Payment System (OPPS) using Ambulatory Payment Classifications (APCs).
Question 2: Which Medicare form is used to submit outpatient hospital radiology claims?
- CMS-1450 (UB-04) (Correct answer)
- CMS-1500
- ADA Dental Claim
- HCFA-1490
Correct answer: CMS-1450 (UB-04)
Outpatient hospital claims, including radiology, are submitted on the CMS-1450 (UB-04) claim form.
Question 3: What is the Medicare global period for most radiology procedures?
- 0 days (XXX indicator) (Correct answer)
- 10 days
- 90 days
- 000 days
Correct answer: 0 days (XXX indicator)
Most radiology procedures carry the 'XXX' global period indicator, meaning the concept of global period does not apply.
Question 4: Medicare requires a written order for which imaging modality before services are rendered?
- All advanced imaging under AUC program (Correct answer)
- Only X-rays
- Only MRI studies
- All imaging over $500
Correct answer: All advanced imaging under AUC program
The Appropriate Use Criteria (AUC) program requires ordering physicians to consult AUC for advanced diagnostic imaging including CT, MRI, and nuclear medicine.
Question 5: Which modifier signals that a service was performed in a Medicare-approved Ambulatory Surgery Center?
- Modifier SG (Correct answer)
- Modifier 79
- Modifier 24
- Modifier 58
Correct answer: Modifier SG
Modifier SG is used by ASCs to indicate the facility fee for services performed in that setting.
Question 6: Under Medicare, which component of a radiology service is billed by the radiologist personally?
- Professional component (Modifier 26) (Correct answer)
- Technical component (Modifier TC)
- Global service
- Facility fee
Correct answer: Professional component (Modifier 26)
Radiologists bill the professional component using Modifier 26, representing the physician's interpretation and report.
RCC Medicare & Payer-Specific Radiology Billing 1
Medicare's facility fee schedule for outpatient radiology is governed by which system?