Section 418.10925. Billing requirements for other licensed facilities.

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(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-9- CM, until ICD-10-CM is implemented, then ICD-10-CM 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.

History: 1998-2000 AACS; 2003 AACS; 2005 AACS; 2008 AACS; 2014 AACS.

                    
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