Q&A: Type of Bill 013X versus 085X

October 18, 2016
Medicare Web

Q: Is it appropriate for a critical access hospital (CAH) hospital to bill with Type of Bill (TOB) 013X versus TOB 085X, or are they only to bill with 085X?

A: A CAH is paid under the cost-based methodology and TOB 085X is used for all outpatient services to identify this type of facility for the application of specific Medicare claims processing. Non-patient laboratory specimens (those not meeting the criteria for reasonable cost payment in the Medicare Claims Processing Manual, Chapter 4 §250.6) should be billed on TOB 014X and those services are paid under the clinical laboratory fee schedule. A CAH should not use TOB 013X as this indicates to Medicare that the facility is billing for services paid under the outpatient prospective payment system and specific coding/billing/payment edits would apply that would not be appropriate in the CAH setting.

Editor’s note: Debbie Mackaman, RHIA, CPCO, CCDS, instructor for HCPro’s Medicare Boot Camp®—Hospital Version and lead instructor for the Critical Access Hospital Version and Rural Health Clinic Version, answered this question. 

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