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Hi Guest!
Great question. The coding you mentioned sounds appropriate. As for indicating it is a purchased service on the medical claim that you are paying for, you will want to mark "yes" in field 20 for outside lab and then enter the amount paid. In field 32, you will want to indicate the outside provider's information (name, address & NPI). Here are the instructions from the CMS1500 claim form manual:
TITLE: Outside Lab? $Charges
INSTRUCTIONS: Complete this field when billing for purchased services by entering an X in “YES.” A “YES” mark indicates that the reported service was provided by an entity other than the billing provider (for example, services subject to Medicare’s anti-markup rule). A “NO” mark or blank indicates that no purchased services are included on the claim.
If “YES” is marked, enter the purchase price under “$Charges” and complete Item Number 32. Each purchased service must be reported on a separate claim form as only one charge can be entered.
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I sent a CT scan of a patient to an outside radiology reading service. I would like to include this service, which I pay for, on form 1500. I am thinking of using CPT 76140 with modifier -26, is this correct? Also, what do I write under "rendering provider ID #"? I didn't perform the service so I can't write my NPI, but I did pay the outside facility for it. Is this actually possible to do? Thank you
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