Medicare Claim Analysis
For User: bulrich Consolidated Billing Services, Inc 104 S Freya, Suite 119, WFB Spokane, WA 99202
Report Date: 10/3/2007 - 5:45:20 PM Eastern

Based on the information you provided, these services were performed in a Non-hospital Outpatient Setting.

The SNF is not responsible for these charges.
HCPCS	Date of Service	Description	Mod	Source	PC/TC	Status	Units	Charge	Allow
71250	4/23/2007	Ct thorax w/o dye	26	RVU	1	A	1	$525.00	$54.68
71250	4/23/2007	Ct thorax w/o dye	NO	RVU	1	A	1	$525.00	$282.15
73510	4/23/2007	X-ray exam of hip	26	RVU	1	A	1	$83.00	$10.11
73510	4/23/2007	X-ray exam of hip	NO	RVU	1	A	1	$83.00	$33.61
73550	4/23/2007	X-ray exam of thigh	26	RVU	1	A	1	$78.00	$8.22
73550	4/23/2007	X-ray exam of thigh	NO	RVU	1	A	1	$78.00	$29.87
73564	4/23/2007	X-ray exam, knee, 4 or more	26	RVU	1	A	1	$89.00	$10.48
73564	4/23/2007	X-ray exam, knee, 4 or more	NO	RVU	1	A	1	$89.00	$36.22
74230	4/23/2007	Cine/vid x-ray, throat/esoph	26	RVU	1	A	1	$116.00	$25.11
74230	4/23/2007	Cine/vid x-ray, throat/esoph	NO	RVU	1	A	1	$116.00	$79.25
93734	4/23/2007	Analyze pacemaker system	26	RVU	1	A	1	$24.00	$19.13
93734	4/23/2007	Analyze pacemaker system	NO	RVU	1	A	1	$24.00	$34.23

The SNF is responsible for these charges.
HCPCS	Date of Service	Description	Mod	Source	PC/TC	Status	Units	Charge	Allow
71250	4/23/2007	Ct thorax w/o dye	TC	RVU	1	A	1	$525.00	$227.47
73510	4/23/2007	X-ray exam of hip	TC	RVU	1	A	1	$83.00	$23.50
73550	4/23/2007	X-ray exam of thigh	TC	RVU	1	A	1	$78.00	$21.65
73564	4/23/2007	X-ray exam, knee, 4 or more	TC	RVU	1	A	1	$89.00	$25.73
74230	4/23/2007	Cine/vid x-ray, throat/esoph	TC	RVU	1	A	1	$116.00	$54.13
93734	4/23/2007	Analyze pacemaker system	TC	RVU	1	A	1	$24.00	$15.09

Code	Mod	CBSI Comments
71250	26
71250	NO
71250	TC	Code is excluded from the SNF bundle when provided on an outpatient hospital basis. TOB 13X
73510	TC	This code was reported as "not bundled" in error. It is bundled to the SNF
73510	NO	This is a global code and is not bundled back to the SNF. Only "TC" modifier portion of this code should be bundled to the SNF
73510	26
73550	26
73550	NO	This is a global code and is not bundled back to the SNF. Only "TC" modifier portion of this code should be bundled to the SNF
73550	TC
73564	TC
73564	NO	This is a global code and is not bundled back to the SNF. Only "TC" modifier portion of this code should be bundled to the SNF
73564	26
74230	26
74230	NO	This is a global code and is not bundled back to the SNF. Only "TC" modifier portion of this code should be bundled to the SNF
74230	TC
93734	TC
93734	NO	This is a global code and is not bundled back to the SNF. Only "TC" modifier portion of this code should be bundled to the SNF
93734	26

Status Code	Status Description
A	These codes are paid separately under the physician fee schedule, if covered. The presence of an "A" indicator does not mean that Medicare has made a national coverage determination regarding the service; carriers remain responsible for coverage decisions in the absence of a national Medicare policy.

Source	Source Description
RVU	These prices are calculated from relative value units and geogrpahic practice indeces. Where applicable they are based on the facility rate

PC/TC Indicator	PC/TC Description
1	Diagnostic Test or Radiology Service - Identifies codes that describe diagnostic tests. Examples are pulmonary function tests or therapeutic radiology procedures, e.g., radiation therapy. These codes have both a professional and technical component. Mo