R 418.10925 Billing requirements for other licensed facilities.

Rule 925. (1) A licensed facility, other than a hospital or freestanding surgical outpatient facility, shall bill the facility services on the UB-04 national uniform billing claim form and shall include the revenue codes contained in the Official UB-04 Data Specifications Manual, ICD-10- CM and ICD-10-PCS coding for diagnoses and procedures, and CPT procedure codes for surgical, radiological, laboratory, and medicine and evaluation and management services. (2) Only the technical component of a radiological service or a laboratory service shall be billed on the standardized UB-04 national uniform billing claim form. (3) All bills for the professional services shall be billed on a CMS 1500 claim form, using the appropriate CPT procedure code and modifier. (4) A report describing the services provided and the condition of the patient shall be included with the bill.