I had a CT urogram done last month for a kidney stone (which they found). I just got the bill and per my insurance and benefits, I have to pay a $100 co-pay for the using the “facility” (and billed with a CPT code of 74178). Then in a separate bill, I have another $100 co-pay for the “professional” fee for the radiologist read (also billed with a CPT code of 74178). I called the billing department and insurance company and they both claim this is being billed correctly, because one is for the facility use (because the CT scanner was in a hospital, not a stand-alone imaging facility?) and one is the professional.

Is this common practice? I actually practice as a pathologist and patients don’t have to separate co-pays between having the procedure/biopsy and the professional pathologist read. It’s generally understood that the pathology read is part of the work-up of that biopsy. Why wouldn’t a CT scan and its associated read be billed into one visit and co-pay? My urologist is asking that I get a second CT scan done before he goes in to get the stone out, but I don’t think that is worth the $200 each time.

See also  Added to Spouse's Standard Family Plan while Currently Having Family HDHP