Question
I am a pediatric audiologist working in a ENT physician's office. We were looking to expand our services to include sedated ABR testing performed in an ambulatory surgery center. We were informed by the surgery center that the audiologist's fees would be reimbursed by private 3rd party payers, but that the anesthesia and facility fees are only covered if the ABR is performed in a hospital facility. What is the reason for this and is this a situation that could change in the future?
Answer
I did some checking on anesthesia billing in ambulatory surgery centers. Anesthesia services should be eligible for reimbursement if performed by an anesthesiologist. However, many ambulatory surgery centers use nurse anesthetists who cannot bill on their own authority. Their billing needs to be tied into a physician-provided procedure with a modifier provided by the physician to show that the nurse anesthetist provided the anesthesia services unsupervised by an anesthesiologist. Based on what I found, my speculation is that the surgery center cannot be reimbursed for anesthesia services because the provider is an audiologist and not a physician. If the anesthesia service were to be provided by or supervised by an anesthesiologist who would bill on behalf of the nurse anesthetist, then possibly that service could be paid for.
Facility fees can only be processed by a hospital. A physician's office does not qualify to bill a facility fee because, in reality, the facility fee is a technical component of the CPT code of the procedure that's been performed. In a physician's office, the global fee is billed which includes a professional component and the technical component. In a hospital setting, the hospital bills the technical component of the anesthesia professional codes.
Robert C. Fifer, Ph.D. is currently the Director of Audiology and Speech-Language Pathology at the Mailman Center for Child Development, Department of Pediatrics, University of Miami School of Medicine. He received his B.S. degree from the University of Nebraska at Omaha in Speech-Language Pathology with a minor in Deaf Education. His M.A. degree is from Central Michigan University in Audiology. And his Ph.D. degree is from Baylor College of Medicine in Audiology and Bioacoustics. Dr. Fifer's clinical and research interests focus on the areas of auditory evoked potentials, central auditory processing, early detection of hearing loss in children, and auditory anatomy and physiology. He is the immediate Past-President of the Florida Association of Speech-Language Pathologists and Audiologists, a member of ASHA's Health Care Economics Committee, and the ASHA representative to the American Medical Association's Health Care Professions Advisory Committee for the Relative Value Utilization Committee in addition to being ASHA's representative to the AMA's Practice Expense Advisory Committee. Additional responsibilities at the state level include serving as a consultant to the Florida Department of Health's Children's Medical Services and the audiology representative to the Genetics and Newborn Screening Advisory Council.
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