Coalition questions

Q. Is a physician allowed to perform “incident to” services to another physician?

A. Indicator 5 denotes services covered incident to a physician’s service when they are provided by auxiliary personnel employed by the physician and working under the doctor’s direct personal supervision. Payment may not be made by carriers for these services when they are provided to hospital inpatients or patients in a hospital outpatient department. Modifiers 26 and TC cannot be used with these codes.

Q. Units of Services vs. Modifier 76

When performing a service that has multiple units, such as 93010, what is the preferred way to bill Medicare? Should physicians bill one line item listing multiple units or list multiple line items with modifier 76 on the additional services? An example would be: When an office called regarding a denied claim, practice staff was told they could not use units of service. They were to use modifier 76 and they were referred to the Medicare manual.

A. They should list multiple line items on additional services as additional line items with the modifier 76. The Customer Care representative was correct to advise the provider to reference the manual for guidance.

For a repeat procedure by the same physician,the physician may need to indicate that a procedure or service was repeated subsequent to the original procedure or service.

Q. Customer care

Physicians are often referred to the Medicare manual in order to obtain answers to questions when calling Customer Care. Would it be possible to provide the name of the manual, chapter and section number in order to easily access the information?

A. Yes, it would be possible to include all the information you have asked for, although if this were done routinely, the call lengths would or could be excessive. The call center is not staffed to walk each and every provider through the Medicare manuals.

In many cases, the Customer Care representative (CCR) does provide a reference, especially if the provider is not aware of the location the CCR is referring them to. Also, the caller can ask for better reference information and the CCR would be more than happy to assist in that case.

Q. PTAN

What number will be required for the Provider Transaction Access Number (PTAN)? Will it be the Unique Physician Identifier Number (UPIN) or the Legacy number? If UPIN is no longer being issued, how would a new physician use it?

A. Background: CMS is requiring that contractors include a reference to the National Provider Identifier (NPI) and the assigned PTAN in all provider enrollment approval letters.

Policy: As a part of Medicare’s implementation of the NPI, CMS is requiring contractors to include the approved NPIs and PTANs in all letters informing suppliers that their enrollment has been approved. The letter shall instruct suppliers to use the NPI on all claims submitted to Medicare and to use the PTAN as an identifier on all inquiries made via the interactive voice response system. Development and use of the PTAN for inquiries is explained in CR 5061 and CR 5089.

Contractors should add the approved NPIs and the assigned PTANs to the provider enrollment approval letter. All PTANs issued to a supplier, including PTANs assigned to a group member, should be included with the approval letter.

Q. Telephone reopening

The NGS Provider Desk Reference indicates you may have a telephone reopening for a change in number of units of service. It does not indicate how many units you can add. Physicians are being told that they can only increase by one unit for a reopening, but must go to the appeal level for addition of more than one unit. Please clarify NGS policy.

A. No, they would change the units for more than one unit. The only time physicians would dispute a unit’s change would be due to the amount of units that were reasonably high.

For example, a provider who requests to change ambulance mileage from 22 to 1,000 would trigger the appeals representative to question the drastic change. To clarify again, the appeals unit does accept unit changes higher than one unit.

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