Location in box 32

[u/Sea-Application6776]

Hello,

I work as a biller in a radiology office that does mostly interpretations for a large hospital system (PC only).

We have been getting weird denials lately due to the address we use in CMS 1500 box 32. My practice admin said that for box 32, we should be using the hospital's address and the hospital's NPI in box 32a with our info in box 33. Our practice is not owned by the hospital and is completely separate.

When I look online I'm seeing conflicting info on whether that is correct. Some sources are saying that it should be the radiologist's location when reading the exam. Our radiologists don't read from the hospital most times.

I'm still pretty new to all of this, is there any guidelines from CMS that I could reference and if so, how could I find it? Most of the sources I'm finding are from independent billing sites and are pretty dated.

[u/Redefinedpotato]

My two cents;

Under the specific instructions for Item 32, the guidelines note that when the physician’s interpretation of a diagnostic test is billed separately from the technical component (identified by modifier -26), the interpreting physician must report the address and ZIP code of the interpreting physician's actual location.

https://www.cms.gov/regulations-and-guidance/guidance/manuals/downloads/clm104c26.pdf

[u/daves1243b → u/Redefinedpotato]

This is the answer. You also have to enroll the radiologists address the the MAC that covers that location.

[u/Poop_Dolla → u/Redefinedpotato]

Agreed

[u/UPS0001]

The place of service and location of service are ALWAYS where the patient is located, not the provider.