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Can we charge for an insertion of a peripherally inserted central catheter (PICC) line when a certified registered nurse performs it? Or must a physician perform it for us to receive reimbursement?

Ask The Expert, August 22, 2006

Q: Can we charge for an insertion of a peripherally inserted central catheter (PICC) line when a certified registered nurse performs it? Or must a physician perform it for us to receive reimbursement?

A: You can charge for the PICC insertion when a certified registered nurse performs it as long as a physician orders the procedure and the nurse documents it sufficiently.

CMS developed CPT for physicians, but it also instructs other facility providers to use the codes when billing facility services under the OPPS. For example, nurses and other ancillary staff perform procedures such as injections, infusions, respiratory procedures, and more.

Although the PICC code descriptor doesn't indicate that a physician must perform the service, refer to the following language in the Medicare Intermediary Manual:

CPT codes are used by physicians to report physician service and do not necessarily reflect the technical component of a service furnished by the hospital. Therefore, hospitals should ignore any wording in the CPT-4 codes that indicates that the service must be performed by a physician.

Reference:

Medicare Intermediary Manual, section 3627.9.