Provider Notice issued 06/30/16

Hospital Fee-for-Service Billing for Electrocardiograms (ECG) and Visit Codes

This notice provides guidance regarding allowable fee-for-service charges by hospitals in the outpatient setting.

Electrocardiograms

Hospitals bill outpatient procedures identified in the Ambulatory Procedures Listing (APL) as institutional services on the 837I electronic transaction or UB-04 paper claim form. Hospitals may bill certain services as fee-for-service on the 837P or HFS 2360 paper claim form. The fee-for-service procedures for hospitals are identified in Chapter A-200, Handbook for Practitioner Services. ECG procedures are not listed in the APL and have not been specifically identified in the Handbook for Practitioner Services as allowable fee-for-service charges by hospitals in the outpatient setting.

Effective with dates of service on and after July 1, 2016, hospitals may bill the technical component CPT code for an ECG procedure (tracing only, without interpretation and report) fee-for-service in the hospital outpatient setting.

The professional component CPT code for an ECG procedure (interpretation and report only) must be billed under the name and NPI of the practitioner performing that service.

The global CPT code for an ECG procedure (routine ECG with at least 12 leads; with interpretation and report) should not be billed by hospitals or practitioners in the hospital outpatient setting.

Inappropriate Billing of Evaluation and Management Codes under Hospital NPI

Professional services are to be billed under the practitioner’s name and NPI. Evaluation and management codes are not allowable fee-for-service charges by hospitals with the exception of CPT code 99211 with the “TH” modifier. This code may be billed for OB triage when there is no billable APL service.  

Any questions regarding this notice may be directed to a medical assistance consultant in the Bureau of Professional and Ancillary Services at 1-877-782-5565.

Felicia F. Norwood

Director