Breast Biopsies performed at IDTF

Please note this question was answered in 2017. The coding advice may or may not be outdated.


The facility my radiologists contract with just changed their accreditation at one location, from an outpatient hospital department to an IDTF. Breast biopsies are being performed at the “new” facility. We are having trouble getting reimbursed for the surgical codes of the breast biopsy. The remit states: “Payment adjusted because the payer deems the information submitted does not support this many/frequency of services.” From what I have read, only the physician performing the biopsy can bill for the surgical codes for a breast biopsy. This is split billing of course, not global. Can you please give information and guidance on this situation?

Question ID: 9239
Sign up for a membership to view the answer to this question.