When you a perform a Medicare service that is global, has both a professional and a technical component, or spans days or months, you need to know what date Medicare considers to be the official date of service when you file your claim.
Here is some guidance from the Centers for Medicare & Medicaid Services (CMS) about coding and billing dates of service on professional claims.
Typically, radiology services have separate professional and technical components. These services will have a PC/TC indicator of “1” on the Medicare Physician Fee Schedule Relative Value File.
- When billing a global service, you can submit as the date of service the date you complete the review and interpretation (professional component) OR the date you perform the radiology study on the patient (technical component). CMS said this will make it easier for Medicare and supplemental payers to process the claim.
- If you performed only one component, not a global service, the date of service for the technical component would be the date the patient receives the service, and the date of service for the professional component would be the date you complete the review and interpretation.
Home health certification and recertification
- The date of service for the certification is the date you complete and sign the plan of care.
- The date of recertification is the date you complete the review.
For more information, see the Medicare Claims Processing Manual, Chapter 12, Section 180.1.B.
Transitional care management
Traditional care management services are 30-day services provided when a patient is discharged from an appropriate facility and still requires moderate or high-complexity medical decisionmaking. The date of service is the date you complete the required face-to-face visit. Keep in mind, there are additional services to be provided during the 30-day period, such as assessing the need for and following up on tests and treatments, coordinating with the health care professional who will assume care for the patient, and arranging for community services (see the TCM FAQs and fact sheet on the CMS website).
Cardiovascular monitoring services
Many different procedure codes represent cardiovascular monitoring services. These can be identified as professional components, technical components, or a combination of the two. Some of these monitoring services may take place at a single point in time, others over 24 or 48 hours, or over 30 days. The date of service is based on the description of the procedure code and the time listed.
- When the service includes a physician review and/or interpretation and report, the date of service is the date you complete that activity.
- If the service is a technical service, the date of service is the date the monitoring concludes, based on the description of the service. For example, if the description of the procedure code includes 30 days of monitoring and a physician interpretation and report, then the date of service will be the date you complete the interpretation and report but no earlier than the 30th day of monitoring.
For more information, see the Medicare National Coverage Determination Manual, Chapter 1, Section 126.96.36.199.
Medicare pays for most surgical services using the global surgery rules. All services considered part of the global package – including follow-up visits – are considered to have occurred on the same day as the surgical service and are not submitted separately.
- If you perform the surgery and then transfer post-operative care to another physician, submit your claim using the date of the surgery as the date of service along with modifier 54.
- If you (surgeon) keep responsibility for the patient for some of the post-operative care, submit the date of the surgery, the surgery procedure code with modifier 55, and the last date of responsibility indicated in Item 19 of the claim or the electronic equivalent.
- The physician receiving the transfer of care will submit his or her post-operative services using the surgical procedure code with modifier 55 and the date of the surgery as the date of service. If this physician receives the patient on a date other than the discharge date from an inpatient stay, Item 19 or the electronic equivalent will show the date care began.
For more information, see the Medicare Claims Processing Manual, Chapter 12, Section 40.
- All expenses incurred for surgical and obstetrical care – including preoperative/prenatal examinations, testing, and post-operative/postnatal services – are part of the maternity package and may be billed under the appropriate surgical code on the date of delivery or termination of the pregnancy.
- Charges you may impose unrelated to the delivery are incurred on the date furnished.
For more information, see the Medicare Benefit Policy Manual, Chapter 15, Section 20.1.
Source: MLN Matters No. SE17023 Revised