CPT coding for outpatient surgery facilities – Do you get charged twice?
Probably a silly question, but is it typical for a doctor to bill for the same procedure, using the same CPT code, as the outpatient surgery center the surgery was done in? I’m trying to make sense of my spouse’s turbinate reduction surgery EOB, and our insurance was billed by both the surgery center and the doctor for the same thing – but it was only done once (spouse only has the one nose and only had the one surgery). Is it because it’s actually one bill but split between them?
If that’s the case – where does all the *extra* charge come from? When I get “cost estimates” for the same code on my insurance website, it says it will be some trivial amount, like $75, but then the total bill for the surgery (using the same CPT codes, and not including anything else like anesthesia) is like $20,000. Am I missing something here? I know facility fees are a thing, but I don’t see why that wouldn’t be a separate charge – otherwise, the online estimates are meaningless, as there’s no way to know what the facility fees will be.