Q&A: Rural health EKG billing during an IPPE

Q. How should rural health clinics (RHC) bill for an EKG performed at the time of an initial preventive physical exam (IPPE)?

A. When an EKG (G0405) is performed in conjunction with the IPPE, the professional component of the diagnostic test is considered to be part of the RHC visit. However, the technical component of the EKG (G0404) cannot be billed on TOB 071X. If an EKG is performed in conjunction with the IPPE at an independent RHC, the practitioner who performs the service may bill for the technical component on the CMS-1500 claim form to the Part B MAC. If an EKG is performed in conjunction with the IPPE at a provider-based RHC, the technical component can be billed by the main provider on their usual outpatient type of bill (e.g., TOB 0851 CAH or TOB 0131 OPPS). For both the professional and technical components of the EKG, neither the deductible nor coinsurance is waived.

For more information on RHC billing and compliance, join Debbie Mackaman, RHIA, CPCO, CCDS, at 12 p.m. (Eastern) Thursday, March 29, for the three-hour RHC virtual workshop or see The Essential Rural Health Clinic Billing and Management Guide.

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