Awareness : OBC Tips

Correct Date of Service for Specific Services

Physicians and non-physician practitioners need to identify the correct date of service (DOS) for the services they provide to a Medicare patient. Most services, with some exceptions, must be billed to Medicare reflecting the exact date the services were performed for or provided to the patient.

Providers types affected:

  • Physicians
  • Non-physician practitioners
  • Others submitting claims on a CMS-1500 form for Medicare Part b reimbursement

Radiology Services

Radiology services have two separate components, a professional (PC) and technical component (TC). These services will have a PC/TC indicator of “1” on the Medicare Physician Fee Schedule Relative Value File. The technical component is billed on the date the patient had the test performed. The professional component is billed on the date the physician provided the interpretation and report of the radiology service. If these are on different dates, these must be billed on different dates and with modifier -TC for the technical component and modifier -26 for the professional component.

Surgical and Anatomical Pathology

Surgical and anatomical pathology services may have two components; a professional and a technical component. These services will have a PC/TC indicator of “1” on the Medicare Physician Fee Schedule Relative Value File. The technical component is billed on the date the specimen was collected. This would be the surgery date. The professional component is billed on the DOS the physician provided the interpretation and report of the pathology service. If these occur on different dates, these must be billed on different dates and with modifier -TC for the technical component and modifier -26 for the professional component.

When the collection spans two calendar dates, use the date the specimen collection ended.

Stored specimens: If the test is performed on a stored specimen (stored less than or equal to 30 calendar days), the date of service is the date the test was performed if certain criteria are met.

  • The test is ordered at least 14 days following the patient’s discharge from the hospital;
  • Specimen was collected during a hospital procedure;
  • It would be medically inappropriate to have collected the same other than during the hospital procedure;
  • Results of the test do not guide treatment during the hospital stay;
  • The test was reasonable and medically necessary.

If the test is ordered on a specimen stored more than 30 days, the DOS for the technical component is the date the specimen is retrieved from storage. The professional component is billed on the date the physician provided the interpretation and report.