For example the office billed a Pano and bitewings. Insurance plan paid at an alternate benefit of FMX can we bill the patient the difference? I was not sure if alternate benefit was the key word.

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  • For example the office billed a Pano and bitewings. Insurance plan paid at an alternate benefit of FMX can we bill the patient the difference? I was not sure if alternate benefit was the key word.

For example the office billed a Pano and bitewings. Insurance plan paid at an alternate benefit of FMX can we bill the patient the difference? I was not sure if alternate benefit was the key word.

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Asked on September 21, 2016
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If the explanation of benefits states there is a patient portion you may bill the patient their cost, however if the benefit is paid at 100% you may not bill the patient. The best option is to appeal the claim stating 14-22 films were not taken at this visit is was a pano and bitewings and per coding guidelines this is a separately billable charge. Coding guidelines state an FMX consists of 14-22 periapical radiographs to include bitewing films. Clearly 14-22 films were not taken as a pano was taken instead.

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Answered on September 22, 2016
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