For claims to intermediaries (FIs), revenue codes, HCPCS code, line item dates of service, units, and applicable HCPCS modifiers are required. Charges must be reported by HCPCS code. If the same revenue code applies to two or more HCPCS codes, providers should repeat the revenue code and show the line item date of service, units, and charge for each HCPCS code on a separate line.
Acceptable HCPCS codes for radiology and other diagnostic services are taken primarily from the Procedure-4 portion of HCPCS. Payment is the lower of the charge or the Medicare physician fee schedule amount. Deductible and coinsurance apply, and coinsurance is based on the allowed amount.