Billing Requirements for Claims Submitted to A/B MACs (A)

60.6 - Billing Requirements for Claims Submitted to A/B MACs (A) (Rev. 10818; Issued: 05-20-21; Effective: 01-09-21; Implementation: 10-04-21) Follow the general bill review instructions in chapter 25. Hospitals use the ASC X12 837 institutional claim format to bill the A/B MAC (A) or the hardcopy Form CMS-1450 (UB-04). Hospitals bill revenue codes and HCPCS codes as follows: Screening Tests/Procedures Revenue Codes HCPCS Codes TOBs FOBT 030X 82270*** (G0107***), G0328 12X, 13X, 14X**, 22X, 23X, 83X, 85X Screening Tests/Procedures Revenue Codes HCPCS Codes TOBs Barium enema 032X G0106, G0120, G0122 12X, 13X, 22X, 23X, 85X**** Flexible Sigmoidoscopy * G0104 12X, 13X, 22X, 23X, 85X**** Colonoscopy-high risk * G0105, G0121 12X, 13X, 22X, 23X, 85X**** Multitarget sDNA - CologuardTM 030X (G0464*****), 81528***** 13X, 14X** 85X Blood-based Biomarker 030X (G0327) 13X, 14X** 85X * The appropriate revenue code when reporting any other surgical procedure. ** 14X is only applicable for non-patient laboratory specimens. *** For claims with dates of service prior to January 1, 2007, physicians, suppliers, and providers report HCPCS code G0107. Effective January 1, 2007, HCPCS G0107, was discontinued and replaced with CPT 82270. **** CAHs that elect Method II bill revenue code 096X, 097X, and/or 098X for professional services and 075X (or other appropriate revenue code) for the technical or facility component. ***** Effective January 1, 2016, HCPCS G0464 is discontinued and replaced with CPT 81528 Special Billing Instructions for Hospital Inpatients When these tests/procedures are provided to inpatients of a hospital or when Part A benefits have been exhausted, they are covered under this benefit. However, the provider bills on TOB 12X using the discharge date of the hospital stay to avoid editing in CWF as a result of the hospital bundling rules.