Tuesday, August 2, 2011

Are CRNA charges billed on a ub-04 or a 1500 for OP claims?

I have always billed my CRNA charges on a 1500 for ALL claims and just recently I have started adding the "QZ" modifier. United Health Care used to be the only company that required this modifier but I think Humana is now wanting it on their claims also. We are a critical access hospital and the Medicare Advantage plans are telling me to bill my claims like I bill medicare. We Do not use the "QZ" modifier for Medicare claims. We use modifier "26" and an "05" value code. Anyways I was readding online and I saw a document that stated the TOB should be an 85X. Obviously if I were to bill an 85X TOB it would have to be on a ub-04 as all of our 1500 have a 100 TOB (we only bill professional charges for 1 surgeon and 1 CRNA. Anyways, can anyone shed some light on this? Or is anyone having the same problem with Medicare Advantage plans?

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