{"id":9942,"date":"2019-10-16T13:22:42","date_gmt":"2019-10-16T07:52:42","guid":{"rendered":"https:\/\/www.medicalbillersandcoders.com\/blog\/?p=9942"},"modified":"2025-07-28T03:22:01","modified_gmt":"2025-07-28T03:22:01","slug":"radiology-part-b-billing-for-hospital-and-snf-patients","status":"publish","type":"post","link":"https:\/\/www.medicalbillersandcoders.com\/blog\/radiology-part-b-billing-for-hospital-and-snf-patients\/","title":{"rendered":"Radiology Part B Billing for Hospital and SNF Patients"},"content":{"rendered":"<p>Acceptable HCPCS codes for radiology and other diagnostic services are taken primarily from the CPT-4 portion of HCPCS. Payment is the lower of the charge or the Medicare physician fee schedule amount. Deductible and coinsurance apply, and coinsurance is based on the allowed amount.<\/p>\n<p>For claims to A\/B MACs (A) or (HHH), revenue codes, HCPCS code, line item dates of service, units, and applicable HCPCS modifiers are required.<\/p>\n<p>Charges must be reported by the HCPCS code. If the same revenue code applies to two or more HCPCS codes, providers should repeat the revenue code and show the line item date of service, units, and charge for each HCPCS code on a separate line.<\/p>\n<ul>\n<li>A\/B MACs (B) may not pay for the technical component (TC) of radiology services furnished to hospital patients. Payment for physicians\u2019 radiological services to the hospital, e.g., administrative or supervisory services, and for provider services needed to produce the radiology service, is made by the AB MAC (A) to the hospital as a provider service.<\/li>\n<li>AB MACs (A) include the TC of radiology services for hospital inpatients, except Critical Access Hospitals (CAHs), in the prospective payment system (PPS) payment to hospitals.<\/li>\n<li>Hospital bundling rules exclude payment to suppliers of the TC of a radiology service for beneficiaries in a hospital inpatient stay. CWF performs reject edits to incoming claims from suppliers of radiology services.<\/li>\n<li>Upon receipt of a hospital inpatient claim at the CWF, CWF searches paid claim history and compares the period between the hospital inpatient admission and discharge dates to the line item service date on a line item TC of a radiology service billed by a supplier. The CWF will generate an unsolicited response when the line item service date falls within the admission and discharge dates of the hospital inpatient claim.<\/li>\n<li>Upon receipt of an unsolicited response, the A\/B MAC (B) will adjust the TC of the radiology service and recoup the payment.<\/li>\n<li>For CAHs, payment to the CAH for inpatients is made at 101 percent of reasonable cost.<\/li>\n<li>Radiology and other diagnostic services furnished to hospital outpatients are paid under the Outpatient Prospective Payment System (OPPS) to the hospital. This applies to bill types 12X and 13X that are submitted to the AB MAC (A). Effective 4\/1\/06, the type of bill 14X is for non-patient laboratory specimens and is no longer applicable for radiology services.<\/li>\n<li>As a result of SNF Consolidated Billing (Section 4432(b) of the Balanced Budget Act (BBA) of 1997), A\/B MACs (B) may not pay for the TC of radiology services furnished to <a href=\"https:\/\/www.medicalbillersandcoders.com\/speciality\/skilled-nursing-facility-medical-billing-services.html\">Skilled Nursing Facility (SNF)<\/a> inpatients during a Part A covered stay. The SNF must bill radiology services furnished its inpatients in a Part A covered stay and payment is included in the SNF Prospective Payment System (PPS).<\/li>\n<li>Radiology services furnished to outpatients of SNFs may be billed by the supplier performing the service or by the SNF under arrangements with the supplier. If billed by the SNF, Medicare pays according to the Medicare Physician Fee Schedule. SNFs submit claims to the AB MAC (A) with the type of bill 22X or 23X.<\/li>\n<\/ul>\n<p><a href=\"http:\/\/bit.ly\/2G9aauK\"><strong>Medical Billers and Coders (MBC)<\/strong><\/a> has billing and coding specialists who are well versed with medical billing and coding updates for Radiology.<\/p>\n<p>To more about our Radiology <a href=\"https:\/\/medicalbillersandcoders.com\/medical-billing-services.aspx\">medical billing services<\/a>, you can contact us at <a href=\"tel:888-357-3226\">888-357-3226<\/a>\/ <a href=\"mailto:info@medicalbillersandcoders.com\">info@medicalbillersandcoders.com<\/a><\/p>\n<p><strong>\u00a0Reference:<\/strong><\/p>\n<p><a href=\"https:\/\/www.cms.gov\/Regulations-and-Guidance\/Guidance\/Manuals\/downloads\/clm104c13.pdf\">Radiology Services and Other Diagnostic Procedures<\/a><\/p>\n<h2>FAQs:<\/h2>\n\n\n<div class=\"schema-faq wp-block-yoast-faq-block\"><div class=\"schema-faq-section\" id=\"faq-question-1753672842531\"><strong class=\"schema-faq-question\">1. What are HCPCS codes for radiology services?<\/strong> <p class=\"schema-faq-answer\">HCPCS codes for radiology are primarily taken from the CPT-4 section and determine payment rates for diagnostic services.<\/p> <\/div> <div class=\"schema-faq-section\" id=\"faq-question-1753672863355\"><strong class=\"schema-faq-question\">2. How is payment determined for radiology claims?<\/strong> <p class=\"schema-faq-answer\">Payment is the lower of the provider&#8217;s charge or the Medicare physician fee schedule amount, subject to deductibles and coinsurance.<\/p> <\/div> <div class=\"schema-faq-section\" id=\"faq-question-1753672874732\"><strong class=\"schema-faq-question\">3. What must be included when submitting claims to A\/B MACs?<\/strong> <p class=\"schema-faq-answer\">Claims must include revenue codes, HCPCS codes, service dates, units, and applicable modifiers to ensure proper processing.<\/p> <\/div> <div class=\"schema-faq-section\" id=\"faq-question-1753672886600\"><strong class=\"schema-faq-question\">4. Are technical components (TC) of radiology services covered for hospital patients?<\/strong> <p class=\"schema-faq-answer\">No, A\/B MACs (B) generally do not pay for the TC of radiology services provided to hospital patients during their stay.<\/p> <\/div> <div class=\"schema-faq-section\" id=\"faq-question-1753672904367\"><strong class=\"schema-faq-question\">5. How should radiology services be billed for Skilled Nursing Facility (SNF) patients?<\/strong> <p class=\"schema-faq-answer\">SNFs must bill radiology services for inpatients under Part A, while outpatient services can be billed by either the SNF or the supplier.<\/p> <\/div> <\/div>\n","protected":false},"excerpt":{"rendered":"<p>Acceptable HCPCS codes for radiology and other diagnostic services are taken primarily from the CPT-4 portion of HCPCS. Payment is the lower of the charge or the Medicare physician fee schedule amount. Deductible and coinsurance apply, and coinsurance is based on the allowed amount. For claims to A\/B MACs (A) or (HHH), revenue codes, HCPCS [&hellip;]<\/p>\n","protected":false},"author":2,"featured_media":19762,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[184],"tags":[714,1126,715,1031,185,1485,186,509,400,380],"class_list":["post-9942","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-radiology-billing-services","tag-billing-radiology-services","tag-cardiology-vs-radiology","tag-outsource-radiology-billing","tag-radiology-billing-company","tag-radiology-billing-services","tag-radiology-charge-entry","tag-radiology-medical-billing","tag-radiology-medical-billing-companies","tag-radiology-medical-billing-services","tag-snf-billing-2"],"yoast_head":"<!-- This site is optimized with the Yoast SEO Premium plugin v27.7 (Yoast SEO v27.7) - https:\/\/yoast.com\/product\/yoast-seo-premium-wordpress\/ -->\n<title>Radiology Part B Billing for 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The main goal of our organization is to assist physicians looking for billers and coders, at the same time help billing specialists looking for jobs, reach the right place.\"},{\"@type\":\"Question\",\"@id\":\"https:\\\/\\\/www.medicalbillersandcoders.tech\\\/blog\\\/radiology-part-b-billing-for-hospital-and-snf-patients\\\/#faq-question-1753672842531\",\"position\":1,\"url\":\"https:\\\/\\\/www.medicalbillersandcoders.tech\\\/blog\\\/radiology-part-b-billing-for-hospital-and-snf-patients\\\/#faq-question-1753672842531\",\"name\":\"1. 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What must be included when submitting claims to A\/B MACs?","answerCount":1,"acceptedAnswer":{"@type":"Answer","text":"Claims must include revenue codes, HCPCS codes, service dates, units, and applicable modifiers to ensure proper processing.","inLanguage":"en-US"},"inLanguage":"en-US"},{"@type":"Question","@id":"https:\/\/www.medicalbillersandcoders.tech\/blog\/radiology-part-b-billing-for-hospital-and-snf-patients\/#faq-question-1753672886600","position":4,"url":"https:\/\/www.medicalbillersandcoders.tech\/blog\/radiology-part-b-billing-for-hospital-and-snf-patients\/#faq-question-1753672886600","name":"4. Are technical components (TC) of radiology services covered for hospital patients?","answerCount":1,"acceptedAnswer":{"@type":"Answer","text":"No, A\/B MACs (B) generally do not pay for the TC of radiology services provided to hospital patients during their stay.","inLanguage":"en-US"},"inLanguage":"en-US"},{"@type":"Question","@id":"https:\/\/www.medicalbillersandcoders.tech\/blog\/radiology-part-b-billing-for-hospital-and-snf-patients\/#faq-question-1753672904367","position":5,"url":"https:\/\/www.medicalbillersandcoders.tech\/blog\/radiology-part-b-billing-for-hospital-and-snf-patients\/#faq-question-1753672904367","name":"5. How should radiology services be billed for Skilled Nursing Facility (SNF) patients?","answerCount":1,"acceptedAnswer":{"@type":"Answer","text":"SNFs must bill radiology services for inpatients under Part A, while outpatient services can be billed by either the SNF or the supplier.","inLanguage":"en-US"},"inLanguage":"en-US"}]}},"_links":{"self":[{"href":"https:\/\/www.medicalbillersandcoders.com\/blog\/wp-json\/wp\/v2\/posts\/9942","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.medicalbillersandcoders.com\/blog\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.medicalbillersandcoders.com\/blog\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.medicalbillersandcoders.com\/blog\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/www.medicalbillersandcoders.com\/blog\/wp-json\/wp\/v2\/comments?post=9942"}],"version-history":[{"count":9,"href":"https:\/\/www.medicalbillersandcoders.com\/blog\/wp-json\/wp\/v2\/posts\/9942\/revisions"}],"predecessor-version":[{"id":25548,"href":"https:\/\/www.medicalbillersandcoders.com\/blog\/wp-json\/wp\/v2\/posts\/9942\/revisions\/25548"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/www.medicalbillersandcoders.com\/blog\/wp-json\/wp\/v2\/media\/19762"}],"wp:attachment":[{"href":"https:\/\/www.medicalbillersandcoders.com\/blog\/wp-json\/wp\/v2\/media?parent=9942"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.medicalbillersandcoders.com\/blog\/wp-json\/wp\/v2\/categories?post=9942"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.medicalbillersandcoders.com\/blog\/wp-json\/wp\/v2\/tags?post=9942"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}