Medicare Physician Fee Schedule Modifiers

Size: px
Start display at page:

Download "Medicare Physician Fee Schedule Modifiers"

Transcription

1 Basics of MPFS Part 3 Medicare Physician Fee Schedule Modifiers Presented by Part B Provider Outreach and Education July 16, 2013

2 Disclaimer This information released is the property of Cahaba GBA and the Centers for Medicare and Medicaid Services (CMS). It may be freely distributed in its entirety but may not be modified, sold for profit or used in commercial documents. While all information in this document is believed to be correct at the time of creation, this document is for educational purposes only and does not purport to provide legal advice. American Medical Association (AMA) Current Procedural Terminology (CPT ) Copyright Statement Current Procedural Terminology (CPT ) is copyright 2013 American Medical Association. All Rights Reserved. CPT is a trademark of the American Medical Association. 2

3 Course Objective 1. Definition of a Modifier 2. How to Identify MPFS modifiers 3. Common MPFS modifier errors 4. Self-Service Tools 5. Medicare Resources 3

4 Acronyms Acronym Term CMS E & M Description Centers for Medicare and Medicaid Services Evaluation and Management MLN Medicare Learning Network MPFS MPFSDB PC TC Medicare Physician Fee Schedule Medicare Physician Fee Schedule Data Base Professional Component Technical Component 4

5 CMS Manual Reference CMS IOM Publication Medicare Claims Processing Manual, Chapter 23 Fee Schedule Administration and Coding Requirements, Section 30 Services Paid Under the Medicare Physician s Fee Schedule found at Guidance/Guidance/Manuals/Downloads/clm104c23.pdf 5

6 Definition What is a Modifier? A two-digit code appended to procedure codes Modifiers May affect reimbursement May be informational only Updated annually 6

7 What is the MPFS database? A list of indicators Provides information about specific codes Edits controlled by CMS Quarterly changes posted in the Medicare B Newsline In addition, MPFS database index file list modifiers 7

8 MPFS Modifiers The Medicare Physician Fee Schedule (MPFS) modifiers may be used to indicate that: A service or procedure has both a professional and technical component A service or procedure was performed by more than one physician An assistant-at-surgery service was performed A bilateral procedure was performed Unusual events occurred 8

9 MPFS Database Index and Relative Value 9

10 Let s Review the MPFS Modifiers Modifier 54 Surgical Care Modifier 55 Postoperative Care Modifier 26 Professional Component Modifier TC Technical Component Modifier 51 Multiple Procedure Modifier 50 Bilateral Procedure Modifier 80 Assistant-at-Surgery (Physician) Modifier AS Assistant-at-Surgery (Non-Physician Practitioner) Modifier 62 Co-Surgery Modifier 66 Team Surgery 10

11 Split care (Transfer of Care) Surgery care only (54) Surgeon is performing only the preoperative and intra-operative care Modifier is only used on surgical codes Commonly used with ophthalmology specialty Postoperative management only (55) Physician, other than surgeon, assumes all or part of postoperative care Copy of written transfer agreement must be kept in beneficiary s medical record 11

12 MPFS Component of Split Care The MPFS shows the pre, intra and post operative percentage Providers should review the MPFSDB for their specific code and applicable percentage System calculates allowance based on fee schedule amount multiplied by percentage rate 12

13 Modifier 54 & 55 Category Indicator Indicator Description Pre % Pre-Operative % - Modifier 56 Intra % Intra -Operative % - Modifier 54 Post % Post -Operative % - Modifier 55 Indicates the percentage of the global allowable for the preoperative portion of the global package. Indicates the percentage of the global allowable for the intra operative portion of the global package including postoperative work in the hospital. Indicates the percentage of the global allowable for the postoperative portion that is provided in the office after discharge from the hospital. Note: Surgeon performing the surgery will be reimbursed for the pre and intra 13

14 A View of the MPFS (Pre, Intra, Post) 14

15 Diagnostic Test Professional Component (26) Interpretation of a diagnostic procedure Technical Component (TC) The equipment and technician performing the test Modifier 26 and TC Affect payment Both modifiers are notated with a specific allowable on the MPFS Refer to the MPFS to verify modifier usage 15

16 Diagnostic Test (26 & TC) P Category Indicator Indicator Description Professional/ Technical Component Modifiers 26 and TC 0 Physician Service codes. Indicator identifies codes that describe physician services such as visits and surgical procedures. Mod 26 & TC cannot be used with these codes. 1 Diagnostic tests or radiology services. Codes generally have both a professional and technical component. Modifiers 26 and TC can be used with these codes. 2 Professional component only codes. This indicator identifies stand alone codes that describe the physician work portion of selected diagnostic tests for which there is an associated code that describes the technical component of the diagnostic test only and another associated code that describes the global test. Modifiers 26 and TC cannot be used with this code. 3 Technical component only codes. This indicator identifies stand alone codes that describe the technical component of selected diagnostic tests for which there is an associated code that describes the professional component of the diagnostic test only. It also identifies codes that are covered only as diagnostic tests and therefore do not have a related professional code. Modifiers 26 and TC cannot be used with this code. 4 Global test only codes. This indicator identifies stand alone codes that describe selected diagnostic tests for which there are associated codes that describe a) the professional component only and b) the technical component of the test only. Modifiers 26 and TC cannot be used with these codes. *This is not an all-inclusive list. 16

17 A View of the MPFS (PC/TC) 17

18 Billing Example CPT CPT code has a PC/TC 4 indicator on MPFS Relative Value file Code described as global test only Modifier 26 or TC should not be appended to this procedure code Incorrect Correct

19 Billing Example CPT CPT code has a PC/TC 3 indicator on MPFS Relative Value file Code described as technical component only Modifier 26 or TC should not be appended to this procedure code TC Incorrect Correct

20 Billing Example CPT CPT code has a PC/TC 2 indicator on MPFS Relative Value file Code described as interpretation only Modifier 26 or TC should not be appended to this procedure code Incorrect Correct

21 Common Billing Errors (Mod 26 & TC) Modifier 26/TC used on same claim line for global procedure Modifier 26 and TC appended to office visit and injection procedure codes Modifier 26 billed on codes that have a PC/TC indicator 2 Modifier TC billed on codes that have a PC/TC indicator 3 21

22 Multiple Procedure (Modifier 51) Multiple procedures other than Evaluation & Management performed at same session, by same physician on the same patient on the same day Do not use with add-on codes Not required for billing Reduction determined by the MPFS approved amount M/S pricing indicators effect surgical procedures, endoscopy rules, technical components, therapy services, cardiovascular and ophthalmology services 22

23 Multiple Procedure (51) M Category Indicator Indicator Description Multiple Surgery Modifier 51 0 No payment adjustment rules for multiple procedures apply. If procedure is reported on same day as another procedure, base payment on lower of a) the actual charge or b) the fee schedule amount for the procedure. 1 Standard payment adjustment rules in effect before January 1, 1996 for multiple procedures apply. In the 1996 MPFSDB, this indicator only applies to codes with procedure status of D. If a procedure is reported on the same day as another procedure with an indicator of 1, 2, or 3, rank the procedures by fee schedule amount and apply the appropriate reduction to this code (100%, 50%, 25%, 25%, 25%, and by report). 2 Standard payment adjustment rules for multiple procedures apply. If procedure is reported on the same day as another procedure with an indicator of 1, 2, or 3, rank the procedures by fee schedule amount and apply the appropriate reduction to this code (100%, 50%, 50%, 50%, 50%, and by report). 3 Special rules for multiple endoscopic procedures apply if procedure is billed with another endoscopy in the same family (i.e., another endoscopy that has the same base procedure). *This is not an all-inclusive list. 23

24 A View of the MPFS (Multiple Procedure) 24

25 Bilateral Procedure (Modifier 50) Surgery performed on both sides of the body at the same operative session or on the same day Always verify the B/S indicator for your procedure code based on the MPFS database file Commonly seen with procedures that allow 150% of MPFS B/S indicator = 1 Number of Service is 1 Bill procedure code on one claim line CPT manual will specify if a code is unilateral, bilateral or unilateral or bilateral 25

26 Bilateral Surgery (50) Category Indicator Indicator Description S Bilateral Surgery 0 150% payment adjustment for bilateral procedures does not apply. Bilateral is inappropriate for codes in this category because of (a) physiology or anatomy, or (b) because the code description specifically states that it is a unilateral procedure and there is an existing code for the bilateral procedure % payment adjustment for bilateral procedures applies. Modifier 50 appropriate if procedure is performed bilaterally. If the code is billed with the bilateral modifier or is reported twice on the same day by any other means (e.g. with RT and LT modifiers or with a 2 in the units field), allows 150% of usual amount % payment adjustment for bilateral procedure does not apply. RVUs are already based on the procedure being performed as a bilateral procedure % payment adjustments for bilateral procedures apply. Modifier 50 appropriate if performed bilaterally. 9 Concept does not apply. 26

27 A View of the MPFS (Bilateral Procedure) 27

28 Common Billing Errors (Mod 50) Modifier 50 used when code descriptions state unilateral or bilateral Billed inappropriately on codes that have a B/S indicator of 0 (Bilateral payment adjustment does not apply) 28

29 Common Billing Error (Mod 50) Incorrect Billing CPT with Modifier 50 and LT for same line (B/S indicator is 1) LT Correct Should bill CPT with modifier on one line with NOS

30 Common Billing Error (Mod 50) Incorrect Billing CPT with Modifier 50 and 2 units of service (B/S indicator is 1) Correct Should bill CPT with modifier on one line with NOS

31 Common Billing Error (Mod 50) Incorrect Billing CPT with Modifier 50 (B/S indicator is 2) Correct Should bill CPT without modifier 50. Code describes unilateral or bilateral in description

32 Assistant-at-Surgery Assists the physician in charge of surgical procedure Modifier 80 used when the assistant at surgery service provided by a medical doctor Allowable based on 16% of MPFS Modifier AS used when the assistant at surgery service provided by a non-physician practitioner Examples include Physician Assistant and Nurse Practitioner Allowable based on 85% of 16% of MPFS MPFS Indicators for services where assistant at surgery allowed: 0 = Payment restrictions for assistants at surgery applies to this procedure unless supporting documentation 2 = Assistant at Surgery may be paid 32

33 Assistant at-surgery (Mod 80 & AS) A Category Indicator Indicator Description Assistant at Surgery Modifiers 80, AS 0 Payment restrictions for assistants at surgery apply to this procedure unless supporting documentation is submitted to establish medical necessity. 1 Statutory payment restriction for assistants at surgery applies to this procedure. Assistant at surgery may not be paid. 2 Payment restriction for assistants at surgery does not apply to this procedure. Assistant at surgery may be paid. 9 Concept does not apply. 33

34 A View of the MPFS (Assistant Surgery) 34

35 Common Billing Error (Mod AS) Incorrect CPT AS was billed by an MD for assistant-at-surgery services. (Assistant-at-Surgery indicator is 2) AS Correct CPT should be used to bill for assistant-at-surgery when performed by an MD

36 Common Billing Errors (Mod 80 & AS) Claims for physician billed with modifier AS Claims for non-physician practitioner billed with modifier 80) Billed inappropriately with codes that have an Assistant-at-Surgery indicator of 1 (Assist at surgery may not be paid) 36

37 Co-Surgery Modifier 62 Two surgeons work together as primary surgeons performing distinct parts of a procedure Both surgeons must agree to use modifier 62 MPFSDB indicator must be 1 or 2 Reimbursement based on 62.5% of allowance for each surgeon 37

38 Co- Surgery (62) Category Indicator Indicator Description C Co-Surgeon Modifier 62 0 Co-surgeons not permitted for this procedure. 1 Co-surgeons could be paid; supporting documentation required to establish the medical necessity of two surgeons for the procedure 2 Co-surgeons permitted; no documentation required if two specialty requirements are met. 9 Concept does not apply. 38

39 A View of the MPFS (Co-Surgery) 39

40 Recovery Auditor Review MLN matters article SE1322 Identified payment errors because of failure to report co-surgeon modifier Individual skills of two or more surgeons are required to perform surgery on the same patient during the same operative session MLN/MLNMattersArticles/Downloads/SE1322.pdf 40

41 Team Surgery Modifier 66 Highly complex procedure requiring skills of different specialties Single procedure requiring more than two surgeons of different specialties Documentation required 41

42 Team Surgery (66) Category Indicator Indicator Description T Team Surgeons Modifier 66 0 Team surgeons not permitted for this procedure 1 Team surgeons could be paid; supporting documentation required to establish medical necessity of a team, pay by report. 2 Team surgeons permitted, pay by report 9 Concept does not apply. 42

43 A View of the MPFS (Team Surgery) 43

44 Proper Coding is the Key! Providers are responsible for determining correct coding for services furnished to Medicare beneficiaries Cahaba GBA shall not make determinations about proper use of codes We will encourage our providers to refer to the most current billing manual Current Procedural Terminology Manual ICD-9-CM manual (diagnosis coding) Level 2 Healthcare Common Procedure Coding System American Hospital Association Coding Clinic 44

45 Website Resources Resource Center for New Providers https://www.cahabagba.com/part-b/education/welcome-to-the-resourcecenter-for-new-providers/ Cahaba University CMS IOM Publication Medicare Claims Processing Manual, Chapter 12 Guidance/Guidance/Manuals/Downloads/clm104c12.pdf 45

46 MM8039: Enrollment Denials Effective October 1, 2013 Implementation date: October 7, 2013 Contractor will deny Form CMS-855 application when an existing or delinquent overpayment exists for Current owner of the applying provider or supplier; or, The applying physician or non-physician practitioner that has an existing overpayment that is equal to or exceeds a threshold of $1500 and it has not been repaid in full at the time the application was filed Forms CMS-855A, CMS-855B, CMS-855I and CMS-855S application 46

47 Electronic Funds Transfer Reminder Missing Medicare Identification Number (aka Provider Transaction Access Number) in Part II Individual PTAN/NPI submitted in lieu of group PTAN/NPI Form CMS-588 not signed by authorized or delegated official Pre-printed voided check or bank letter not attached 47

48 48 Appeals Decision Tree

49 Cahaba GBA Website Secondary links Forms Homepage Redesign InSite Web Portal What s New Foresee Survey 49

50 MLN Products CMS is looking for interested individuals to pilot Volunteers are needed to test web-based training and review MLN publications You should to Provide your name, occupation, state of residence, and address. An confirmation will be sent Details provided in the June 13th edition of the CMS e-news 50

51 Questions 51 Provider Contact Center:

52 Thank You for Joining Us! Participants can obtain the evaluation via one of the following options: 1. Upon the conclusion of the event, the evaluation will be launched; or, 2. Submit your evaluation by using the following link: We appreciate your feedback and comments! 52

Medicare 101: Basics of Modifier Billing. Part B Provider Outreach and Education February 26, 2014

Medicare 101: Basics of Modifier Billing. Part B Provider Outreach and Education February 26, 2014 Medicare 101: Basics of Modifier Billing Part B Provider Outreach and Education February 26, 2014 Housekeeping Tips When you called in, did you enter your attendee code? Dial-in number: 1-800-791-2345

More information

2013 MPFS Indicator Descriptors

2013 MPFS Indicator Descriptors 2013 MPFS Indicator Descriptors Here is an overview of the layout. Use the key on the following pages to interpret indicators. Indicator NOTE - # NOTE - C PROCEDURE/MOD PAR Amount NON-PAR Amount Limiting

More information

Global Surgery Fact Sheet

Global Surgery Fact Sheet DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Medicare & Medicaid Services R Global Surgery Fact Sheet Fact Sheet Definition of a Global Surgical Package Medicare established a national definition

More information

Physician Fee Schedule BCBSRI follows CMS Physician Fee Schedule (PFS) Relative Value Units (RVU) for details relating to

Physician Fee Schedule BCBSRI follows CMS Physician Fee Schedule (PFS) Relative Value Units (RVU) for details relating to Policy Coding and Guidelines EFFECTIVE DATE: 09 01 2015 POLICY LAST UPDATED: 09 02 2015 OVERVIEW This Policy provides an overview of coding and guidelines as they pertain to claims submitted to Blue Cross

More information

Class Action Settlement Recap

Class Action Settlement Recap Class Action Settlement Recap Enhancements to Claim Payment Policy, Processing and Payment Disclosure, and an Appeals Process for Class Action Settlement Providers The following enhancements are effective

More information

1) There are 0 indicator edits, which are never correctly reported together;

1) There are 0 indicator edits, which are never correctly reported together; Medical Coverage Policy Coding and Guidelines sad EFFECTIVE DATE: 11/15/2011 POLICY LAST UPDATED: 11/1/2013 OVERVIEW This Policy provides an overview of coding and guidelines as they pertain to claims

More information

Medicare 101: Basics of CPT. Part B Provider Outreach and Education February 11, 2015

Medicare 101: Basics of CPT. Part B Provider Outreach and Education February 11, 2015 Medicare 101: Basics of CPT Part B Provider Outreach and Education February 11, 2015 Housekeeping Tips When you called in, did you enter your attendee code? Dial-in number: 1-800-791-2345 Attendee (participant)

More information

Inpatient Hospital (21) Office (11) Home (12) June 4, 2014

Inpatient Hospital (21) Office (11) Home (12) June 4, 2014 Inpatient Hospital (21) Home (12) Office (11) 1 June 4, 2014 Today s event is a teleconference Slides will not be advanced during the presentation Attendees are instructed to refer to their handout material

More information

Modifiers 80, 81, 82, and AS - Assistant At Surgery

Modifiers 80, 81, 82, and AS - Assistant At Surgery Manual: Policy Title: Reimbursement Policy Modifiers 80, 81, 82, and AS - Assistant At Surgery Section: Modifiers Subsection: None Date of Origin: 1/1/2000 Policy Number: RPM013 Last Updated: 8/29/2014

More information

Modifier Usage Guide What Your Practice Needs to Know

Modifier Usage Guide What Your Practice Needs to Know BlueCross BlueShield of Mississippi Modifier Usage Guide What Your Practice Needs to Know Modifier 22 Usage Modifier 22 - Procedural Service The purpose of this modifier is to report services (surgical

More information

Status Active. Assistant Surgeons. This policy addresses reimbursement for assistant surgical procedures during the same operative session.

Status Active. Assistant Surgeons. This policy addresses reimbursement for assistant surgical procedures during the same operative session. Status Active Reimbursement Policy Section: Surgery/Interventional Procedure Policy Number: RP - Surgery/Interventional Procedure - 001 Assistant Surgeons Effective Date: June 1, 2015 Assistant Surgeons

More information

CODE AUDITING RULES. SAMPLE Medical Policy Rationale

CODE AUDITING RULES. SAMPLE Medical Policy Rationale CODE AUDITING RULES As part of Coventry Health Care of Missouri, Inc s commitment to improve business processes, we are implemented a new payment policy program that applies to claims processed on August

More information

Modifier Reference PAYMENT POLICY ID NUMBER: 10-011. Original Effective Date: 05/14/10. Revised: 05/31/12 DESCRIPTION:

Modifier Reference PAYMENT POLICY ID NUMBER: 10-011. Original Effective Date: 05/14/10. Revised: 05/31/12 DESCRIPTION: Private Property of Florida Blue. This payment policy is Copyright 2012, Florida Blue. All Rights Reserved. You may not copy or use this document or disclose its contents without the express written permission

More information

Page 1 of 11. MLN Matters Number: SE1010 REVISED Related Change Request (CR) #: 6740. Related CR Release Date: N/A Effective Date: January 1, 2010

Page 1 of 11. MLN Matters Number: SE1010 REVISED Related Change Request (CR) #: 6740. Related CR Release Date: N/A Effective Date: January 1, 2010 News Flash Version 3.0 of the Measures Groups Specifications Manual released in November 2009 for 2010 PQRI has been revised. Version 3.1 of the 2010 PQRI Measures Groups Specifications Manual and Release

More information

WELLCARE CLAIM PAYMENT POLICIES

WELLCARE CLAIM PAYMENT POLICIES WellCare and Harmony Health Plan s claim payment policies are based on publicly distributed guidelines from established industry sources such as the Centers for Medicare and Medicaid Services (CMS), the

More information

Empire BlueCross BlueShield Professional Reimbursement Policy

Empire BlueCross BlueShield Professional Reimbursement Policy Subject: Modifier Rules NY Policy: 0017 Effective: 02/01/2014 06/30/2014 Coverage is subject to the terms, conditions, and limitations of an individual member s programs or products and policy criteria

More information

Payment of Assistant at Surgery Services in a Method II Critical Access Hospital (CAH)

Payment of Assistant at Surgery Services in a Method II Critical Access Hospital (CAH) MLN Matters Number: MM6123 Related Change Request (CR) #: 6123 Related CR Release Date: October 24, 2008 Effective Date: January 1, 2008 Related CR Transmittal #: R1620CP Implementation Date: April 6,

More information

MEDICAL POLICY Modifier Guidelines

MEDICAL POLICY Modifier Guidelines POLICY.........PG0011 EFFECTIVE......10/30/05 LAST REVIEW... 10/13/15 MEDICAL POLICY Modifier Guidelines GUIDELINES This policy does not certify benefits or authorization of benefits, which is designated

More information

Modifiers 58, 78, and 79 Staged, Related, and Unrelated Procedures

Modifiers 58, 78, and 79 Staged, Related, and Unrelated Procedures Manual: Policy Title: Reimbursement Policy Modifiers 58, 78, and 79 Staged, Related, and Unrelated Procedures Section: Modifiers Subsection: None Date of Origin: 9/22/2004 Policy Number: RPM010 Last Updated:

More information

Status Active. Reimbursement Policy Section: General Coding Section Policy Number: RP-General Coding-001.002 Modifier Effective Date: July, 2016

Status Active. Reimbursement Policy Section: General Coding Section Policy Number: RP-General Coding-001.002 Modifier Effective Date: July, 2016 Status Active Reimbursement Policy Section: General Coding Section Policy Number: RP-General Coding-001.002 Modifier Effective Date: July, 2016 Modifier Policy Description: This policy addresses reimbursement

More information

NATIONAL PHYSICIAN FEE SCHEDULE RELATIVE VALUE FILE CALENDAR YEAR 2016

NATIONAL PHYSICIAN FEE SCHEDULE RELATIVE VALUE FILE CALENDAR YEAR 2016 NATIONAL PHYSICIAN FEE SCHEDULE RELATIVE VALUE FILE CALENDAR YEAR 2016 Contents: This file contains information on services covered by the Medicare Physician Fee Schedule (MPFS) in 2016. For more than

More information

Radiology Multiple Imaging Reduction Policy

Radiology Multiple Imaging Reduction Policy Policy Number 2015R0085C Radiology Multiple Imaging Reduction Policy Annual Approval Date 7/8/2015 Approved By Payment Policy Oversight Committee IMPORTANT NOTE ABOUT THIS You are responsible for submission

More information

Appropriate Modifier Usage

Appropriate Modifier Usage Anatomical modifiers Anesthesia modifiers EA, EB and EC FB, FC and FD Anatomical modifiers are used to indicate that a procedure or service was performed at a specific anatomic site or to indicate that

More information

5/2/2014. Beginning Biller / Coder 101 Thursday, May 8 1:00 p.m. to 2:30 p.m. Disclaimer. Stay in touch through Facebook Please note

5/2/2014. Beginning Biller / Coder 101 Thursday, May 8 1:00 p.m. to 2:30 p.m. Disclaimer. Stay in touch through Facebook Please note Disclaimer Beginning Biller / Coder 101 Thursday, May 8 1:00 p.m. to 2:30 p.m. Presented by: Judy B Breuker, CPC, CPMA, CCS P, CDIP, CHC, CHCA, CEMC, AHIMA Approved ICD 10 CM/PCS Trainer The class is intended

More information

Modifier Reference Policy

Modifier Reference Policy Policy Number 2015R0111C Annual Approval Date Modifier Reference Policy 11/12/2014 Approved By Payment Policy Oversight Committee IMPORTANT NOTE ABOUT THIS REIMBURSEMENT POLICY You are responsible for

More information

There are two levels of modifiers: Level 1 (CPT) and Level II (CMS, also known as HCPCS).

There are two levels of modifiers: Level 1 (CPT) and Level II (CMS, also known as HCPCS). PROVIDER BILLING GUIDELINES Modifiers Modifiers are two digit or alphanumeric characters that are appended to CPT and HCPCS codes. The modifier allows the provider to indicate that a procedure was affected

More information

100.1 - Payment for Physician Services in Teaching Settings Under the MPFS. 100.1.1 - Evaluation and Management (E/M) Services

100.1 - Payment for Physician Services in Teaching Settings Under the MPFS. 100.1.1 - Evaluation and Management (E/M) Services MEDICARE CLAIMS PROCESSING MANUAL Accessed September 25, 2005 100.1 - Payment for Physician Services in Teaching Settings Under the MPFS Payment is made for physician services furnished in teaching settings

More information

Anthem Blue Cross and Blue Shield (Anthem) CLAIMS XTEN TM RULES Version 4.4 Effective December 8, 2012

Anthem Blue Cross and Blue Shield (Anthem) CLAIMS XTEN TM RULES Version 4.4 Effective December 8, 2012 Rules Edit logic Example Suppted After Hours 99050 not Reimbursable with Preventive Diagnosis This will deny 99050 (services provided when the office is usually closed) when billed with a preventive diagnosis

More information

Intra-operative Nerve Monitoring Coding Guide. March 1, 2011

Intra-operative Nerve Monitoring Coding Guide. March 1, 2011 Intra-operative Nerve Monitoring Coding Guide March 1, 2011 Please direct any questions to: Patty Telgener, RN Vice President, Reimbursement Services Emerson Consultants (303) 526-7604 (office) (303) 570-2159

More information

Professional/Technical Component Policy

Professional/Technical Component Policy Policy Number 2015R0012C Professional/Technical Component Policy Annual Approval Date 1/27/2014 Approved By Payment Policy Oversight Committee IMPORTANT NOTE ABOUT THIS REIMBURSEMENT POLICY You are responsible

More information

Coding and Payment Guide for Anesthesia Services

Coding and Payment Guide for Anesthesia Services Coding and Payment Guide for Anesthesia Services An essential coding, billing, and payment resource for anesthesiology and pain management 2006 4th edition Contents Introduction...............................

More information

Rotator Cuff Repair Surgical Procedures

Rotator Cuff Repair Surgical Procedures Rotator Cuff Repair Surgical Procedures 2011 Reimbursement and Coding Reference Guide for Physicians and Hospitals This coding reference guide is intended to illustrate the common CPT * codes, ICD-9 CM

More information

Modifier Reference Policy

Modifier Reference Policy Policy Number 2016R0111C Annual Approval Date Modifier Reference Policy 11/11/2015 Approved By Payment Policy Oversight Committee IMPORTANT NOTE ABOUT THIS REIMBURSEMENT POLICY You are responsible for

More information

Modifiers. Page 1 of 6

Modifiers. Page 1 of 6 Modifiers A Current Procedural Terminology/Healthcare Common Procedure Coding System (CPT/HCPCS) modifier is a twocharacter (alpha and/or numeric) code appended to a CPT/HCPCS procedure code to clarify

More information

Modifiers. Policy Number: 10.01.503 Last Review: 5/2015 Origination: 12/2004 Next Review: 5/2016

Modifiers. Policy Number: 10.01.503 Last Review: 5/2015 Origination: 12/2004 Next Review: 5/2016 Modifiers Policy Number: 10.01.503 Last Review: 5/2015 Origination: 12/2004 Next Review: 5/2016 Policy Modifiers indicate that a service was altered in some way from the stated descriptor without changing

More information

My Coding Connection, LLC 618-530-1196. 24 Unrelated E/M by the same physician during a postoperative period

My Coding Connection, LLC 618-530-1196. 24 Unrelated E/M by the same physician during a postoperative period MODIFIERS Rachel Coon, CCS-P, CPC, CPC-P, CPMA, CPC-I, CEMC, ICD-10 My Coding Connection, LLC 618-530-1196 GLOBAL PACKAGE MODIFIERS 24 Unrelated E/M by the same physician during a postoperative period

More information

Suzanne Honor-Vangerov, Esq. CPC, CPC-I

Suzanne Honor-Vangerov, Esq. CPC, CPC-I Suzanne Honor-Vangerov, Esq. CPC, CPC-I 1 Managing Attorney, Lien Unit Floyd Skeren & Kelly LLP Owner of Honor System Consulting Prior Manager of the Division of Workers Compensation Medical Unit, in charge

More information

Payment Policy. Evaluation and Management

Payment Policy. Evaluation and Management Purpose Payment Policy Evaluation and Management The purpose of this payment policy is to define how Health New England (HNE) reimburses for Evaluation and Management Services. Applicable Plans Definitions

More information

National Correct Coding Initiative Policy Manual for Medicare Services Revision Date: January 1, 2014

National Correct Coding Initiative Policy Manual for Medicare Services Revision Date: January 1, 2014 National Correct Coding Initiative Policy Manual for Medicare Services Revision Date: January 1, 2014 Current Procedural Terminology 2013 American Medical Association. All Rights Reserved. Current Procedural

More information

What s new in INCISIVE MD? Who should read these release notes?

What s new in INCISIVE MD? Who should read these release notes? April 2009 Contents What s new in INCISIVE MD? Who should read these release notes? National Correct Coding Initiative (CCI) Updates Corrected $0 Expected for Arthroscopic Chondroplasty CCI Edit Additional

More information

2015 Coding & Payment Policy Update

2015 Coding & Payment Policy Update The Society for Cardiovascular Angiography and Interventions presents 2015 Coding & Payment Policy Update Faculty Peter Duffy, MD, MMM, F, Secretary, 2014 2015, Advocacy and Government Relations Committee

More information

Using Modifiers Wisely Steven M. Verno, CEMCS, CMSCS, NREMT-P, CMBSI Medical Coding and Billing Professor 2009

Using Modifiers Wisely Steven M. Verno, CEMCS, CMSCS, NREMT-P, CMBSI Medical Coding and Billing Professor 2009 Using Modifiers Wisely Steven M. Verno, CEMCS, CMSCS, NREMT-P, CMBSI Medical Coding and Billing Professor 2009 Disclaimer: Modifiers are copyrighted and the property of the American Medical Association.

More information

2010 Medicare Part B Consultation Coding Changes 1/26/2010 & 1/27/2010

2010 Medicare Part B Consultation Coding Changes 1/26/2010 & 1/27/2010 2010 Medicare Part B Consultation Coding Changes 1/26/2010 & 1/27/2010 Consultations The Centers for Medicare/Medicaid Services (CMS) finalized its proposal to require claims for consultation services

More information

istent Trabecular Micro-Bypass Stent Reimbursement Guide

istent Trabecular Micro-Bypass Stent Reimbursement Guide istent Trabecular Micro-Bypass Stent Reimbursement Guide Table of Contents Overview Coding 2 3 Coding Overview Procedure Coding Device Coding Additional Coding Information Coverage Payment 8 9 Payment

More information

STS/AATS CODING. NEWSLETTER Recent Information on CPT and ICD-9 CM Codes for Cardiothoracic Surgeons

STS/AATS CODING. NEWSLETTER Recent Information on CPT and ICD-9 CM Codes for Cardiothoracic Surgeons N E W S STS/AATS CODING L E T T E R Vol. 13 No. 1, Spring 2004 2004, The Society of Thoracic Surgeons, Chicago, IL 60611 TEE s; Maze; 0,10, XXX Global Periods; Medicare Usage for Assistants-at- Surgery

More information

Outpatient Therapy Services

Outpatient Therapy Services Outpatient Therapy Services Presented by WPS Medicare Provider Outreach and Education Updated March 2014 http://www.wpsmedicare.com/ Module 1 General Guidelines Acronyms OT Occupational Therapy PT Physical

More information

Medical Practitioner Reimbursement

Medical Practitioner Reimbursement INDIANA HEALTH COVERAGE PROGRAMS PROVIDER REFERENCE M ODULE Medical Practitioner Reimbursement L I B R A R Y R E F E R E N C E N U M B E R : P R O M O D 0 0 0 1 6 P U B L I S H E D : F E B R U A R Y 25,

More information

Modifiers. This modifier can be located in the following rule(s): Anesthesia Global Maternity

Modifiers. This modifier can be located in the following rule(s): Anesthesia Global Maternity The Medical Clean Claims Task force has developed this modifier grid to identify modifiers that are considered to be important in the overall adjudication of a claim from a commercial payer perspective.

More information

istent Trabecular Micro-Bypass Stent Reimbursement Guide

istent Trabecular Micro-Bypass Stent Reimbursement Guide istent Trabecular Micro-Bypass Stent Reimbursement Guide Table of Contents Overview Coding 3 4 Coding Overview Procedure Coding Device Coding Additional Coding Information Coverage Payment 10 11 Payment

More information

Compliance Department SURGERY AND SURGICAL MODIFIERS 11/2010

Compliance Department SURGERY AND SURGICAL MODIFIERS 11/2010 Compliance Department SURGERY AND SURGICAL MODIFIERS 11/2010 Surgical Care Presence Requirements In order to bill for surgical services, teaching physician must be present during all critical and key portions

More information

Part B Education Exclusive: Modifier 59 Edit Update Questions

Part B Education Exclusive: Modifier 59 Edit Update Questions Cahaba GBA would like to provide some clarification of the use of Modifier 59. The modifier is not limited to National Correct Coding Initiative (NCCI) pairs. We apologize for any confusion our July article

More information

Common Billing Mistakes Costing Your ASC Money and Correct Modifier & Revenue Code Usage for ASC Claims

Common Billing Mistakes Costing Your ASC Money and Correct Modifier & Revenue Code Usage for ASC Claims Common Billing Mistakes Costing Your ASC Money and Correct Modifier & Revenue Code Usage for ASC Claims October 2013 Beckers 20 th Annual ASC Conference Presenter: Stephanie Ellis, R.N., CPC, Speaker Ellis

More information

Basic Medical Record Documentation

Basic Medical Record Documentation Basic Medical Record Documentation Presented by Cahaba Government Benefit Administrators, LLC P rovider O u t reach and Education September 19, 2013 1 Disclaimers This resource is not a legal document.

More information

Intraoperative Nerve Monitoring Coding Guide. March 1, 2010

Intraoperative Nerve Monitoring Coding Guide. March 1, 2010 Intraoperative Nerve Monitoring Coding Guide March 1, 2010 Please direct any questions to: Kim Brew Manager Reimbursement and Therapy Access Medtronic ENT (904) 279-7569 Rev 9/10 KB TO OUR PARTNERS IN

More information

Empire BlueCross BlueShield Professional Reimbursement Policy

Empire BlueCross BlueShield Professional Reimbursement Policy Subject: Evaluation and Management Services and Related Modifiers -25 & 57 NY Policy: 0026 Effective: 8/19/2013 1/31/2014 Coverage is subject to the terms, conditions, and limitations of an individual

More information

Reimbursement Policy General Coding Section Policy Number: RP - General Coding - 014 Observation Care Services Effective Date: June 1, 2015

Reimbursement Policy General Coding Section Policy Number: RP - General Coding - 014 Observation Care Services Effective Date: June 1, 2015 Status Active Reimbursement Policy Section: General Coding Section Policy Number: RP - General Coding - 014 Observation Care Services Effective Date: June 1, 2015 Observation Care Services Description:

More information

Corporate Reimbursement Policy

Corporate Reimbursement Policy Corporate Reimbursement Policy File Name: Origination: Last Review: Next Review: modifier_guidelines 1/2000 8/2015 8/2016 Description Policy A modifier enables a provider to report that a service or procedure

More information

Transitional Care Management (TCM) Presented by Noridian Part B Medicare Provider Outreach and Education May 2016

Transitional Care Management (TCM) Presented by Noridian Part B Medicare Provider Outreach and Education May 2016 Transitional Care Management (TCM) Presented by Noridian Part B Medicare Provider Outreach and Education DISCLAIMER This information release is the property of Noridian Administrative Services, LLC (NAS).

More information

Reimbursement Policy. Policy

Reimbursement Policy. Policy Reimbursement Policy Subject: Assistant at Surgery (Modifiers 80/81/82/AS) Effective Date: 07/01/13 Committee Approval Obtained: 07/01/13 Section: Coding *****The most current version of the reimbursement

More information

Corporate Reimbursement Policy

Corporate Reimbursement Policy Corporate Reimbursement Policy Co-Surgeon, Assistant Surgeon, Team Surgeon and Assistant-at-Surgery Guidelines File Name: Origination: Last Review: Next Review: co-surgeon_assistant_surgeon_and_assistant_at_surgery_guidelines

More information

Appendix E: Modifiers that affect payment

Appendix E: Modifiers that affect payment Payment Policies Appendices Appendix E: Modifiers that affect payment Note: Only modifiers that affect payment are listed in this Appendix. Refer to current CPT and HCPCS books for a complete list of modifiers,

More information

Medicare Information for Advanced Practice Nurses and Physician Assistants. September 2010 / ICN: 901623

Medicare Information for Advanced Practice Nurses and Physician Assistants. September 2010 / ICN: 901623 R Medicare Information for Advanced Practice Nurses and Physician Assistants September 2010 / ICN: 901623 This publication provides information about required qualifications, coverage criteria, billing,

More information

Financial Disclosure. Modifiers Getting It Right! Modifiers. Modifiers. Medicare Expected Frequency. Common Modifiers Used Only with Office Visits

Financial Disclosure. Modifiers Getting It Right! Modifiers. Modifiers. Medicare Expected Frequency. Common Modifiers Used Only with Office Visits Financial Disclosure Modifiers Getting It Right! Donna McCune is a consultant for Corcoran Consulting Group and acknowledges a financial interest in the subject matter of this presentation. Donna McCune,

More information

Reciprocal Billing and Locum Tenens. Presented by: Medicare Part B Provider Outreach and Education (POE) May 2016

Reciprocal Billing and Locum Tenens. Presented by: Medicare Part B Provider Outreach and Education (POE) May 2016 Reciprocal Billing and Locum Tenens Presented by: Medicare Part B Provider Outreach and Education (POE) May 2016 Disclaimer This information release is the property of Noridian Healthcare Solutions, LLC

More information

Compliance Risks with Non-Physician Practitioners

Compliance Risks with Non-Physician Practitioners Compliance Risks with Non-Physician Practitioners Kim Huey, MJ, CPC, CCS-P, PCS Health Care Compliance Association Clinical Practice Compliance Conference October 2013 NPP Coding and Billing Definitions

More information

IMPROPER PAYMENTS FOR EVALUATION AND MANAGEMENT SERVICES COST MEDICARE BILLIONS

IMPROPER PAYMENTS FOR EVALUATION AND MANAGEMENT SERVICES COST MEDICARE BILLIONS Department of Health and Human Services OFFICE OF INSPECTOR GENERAL IMPROPER PAYMENTS FOR EVALUATION AND MANAGEMENT SERVICES COST MEDICARE BILLIONS IN 2010 Daniel R. Levinson Inspector General May 2014

More information

CMS Eliminates Medicare Payment for Consultation Codes. Prepared by the UFJHI Office of Physician Billing Compliance

CMS Eliminates Medicare Payment for Consultation Codes. Prepared by the UFJHI Office of Physician Billing Compliance CMS Eliminates Medicare Payment for Consultation Codes Outline Reasons for Change Effective Date New Modifier Impact on Other Payers Impact on Medicare Secondary Claims Code Selection Office/Outpatient

More information

FAQs on Billing for Health and Behavior Services

FAQs on Billing for Health and Behavior Services FAQs on Billing for Health and Behavior Services by Government Relations Staff January 29, 2009 Practicing psychologists are eligible to bill for applicable services and receive reimbursement from Medicare

More information

Mississippi Medicaid. Provider Reference Guide. For Part 203. Physician Services

Mississippi Medicaid. Provider Reference Guide. For Part 203. Physician Services Mississippi Medicaid Provider Reference Guide For Part 203 Physician Services This is a companion document to the Mississippi Administrative Code Title 23 and must be utilized as a reference only. January

More information

Technical Component (TC), Professional Component (PC/26), and Global Service Billing

Technical Component (TC), Professional Component (PC/26), and Global Service Billing Manual: Policy Title: Reimbursement Policy Technical Component (TC), Professional Component (PC/26), and Global Service Billing Section: Modifiers Subsection: None Date of Origin: 1/1/2000 Policy Number:

More information

A Beginner s View of the Provider Enrollment Chain & Ownership System (PECOS)

A Beginner s View of the Provider Enrollment Chain & Ownership System (PECOS) E S Cahaba Presents: A Beginner s View of the Provider Enrollment Chain & Ownership System (PECOS) PRESENTED BY PART B PROVIDER OUTREACH & EDUCATION MAY 23, 2013 1 DISCLAIMER This resource is not a legal

More information

Suppliers are to follow The Health Plan requirements for precertification, as applicable.

Suppliers are to follow The Health Plan requirements for precertification, as applicable. Eye Prostheses Adopted from the National Government Services website. For any item to be covered by The Health Plan, it must: 1. Be eligible for a defined Medicare or Health Plan benefit category 2. Be

More information

MODIFIERS. Original Effective Date: July 7, 2009 Revision Date: February 1 st, 2014

MODIFIERS. Original Effective Date: July 7, 2009 Revision Date: February 1 st, 2014 Original Effective Date: July 7, 2009 Revision Date: February 1 st, 2014 MODIFIERS Policy s are used to increase accuracy in recording patient encounters and compensation. A modifier provides the means

More information

2-Midnight Rule: Implications for Auditor Behavior and Appeal Strategies

2-Midnight Rule: Implications for Auditor Behavior and Appeal Strategies 2-Midnight Rule: Implications for Auditor Behavior and Appeal Strategies Jessica L. Gustafson, Esq. The Health Law Partners, P.C. 29566 Northwestern Hwy., Ste. 200 Southfield, MI 48236 www.thehlp.com 1

More information

Basics of Skilled Nursing Facility Consolidated Billing (SNF-CB) Medicare Part A and B Presentation March 19, 2013

Basics of Skilled Nursing Facility Consolidated Billing (SNF-CB) Medicare Part A and B Presentation March 19, 2013 Basics of Skilled Nursing Facility Consolidated Billing (SNF-CB) Medicare Part A and B Presentation March 19, 2013 2 Agenda Skilled Care Defined Background on SNF-CB Under Arrangements Inclusions and Exclusions

More information

Incident To Services

Incident To Services Policy Number INT04242013RP Approved By Incident To Services UnitedHealthcare Medicare Committee Current Approval Date 11/18/2015 IMPORTANT NOTE ABOUT THIS REIMBURSEMENT POLICY This policy is applicable

More information

CERT: Documentation of Clinical Diagnostic Tests

CERT: Documentation of Clinical Diagnostic Tests CERT: Documentation of Clinical Diagnostic Tests May 29, 2014 Cahaba Government Benefit Administrators, LLC Provider Outreach and Education Disclaimer This resource is not a legal document. The presentation

More information

1. ICD-10-CM, SKILLED NURSING FACILITIES, AND LAB SERVICES

1. ICD-10-CM, SKILLED NURSING FACILITIES, AND LAB SERVICES 1. ICD-10-CM, SKILLED NURSING FACILITIES, AND LAB SERVICES 1.1 ICD-10-CM, SKILLED NURSING FACILITIES, AND LAB SERVICES Welcome to the ICD-10-CM, Skilled Nursing Facilities, and Lab Services training. Please

More information

CORRECT CODING INITIATIVE OB/GYN CPT CODES INTRODUCTION

CORRECT CODING INITIATIVE OB/GYN CPT CODES INTRODUCTION CORRECT CODING INITIATIVE OB/GYN CPT CODES INTRODUCTION 2015 NOTE: CMS UPDATES THE CCI QUARTERLY. FOR THE MOST RECENT VERSION, SEE DEPT. OF HEALTH ECONOMICS AND CODING WWW.ACOG.ORG CMS Correct Coding Initiative

More information

Medicare Preventive Services National Provider Call: The Initial Preventive Physical Exam and the Annual Wellness Visit.

Medicare Preventive Services National Provider Call: The Initial Preventive Physical Exam and the Annual Wellness Visit. Medicare Preventive Services National Provider Call: The Initial Preventive Physical Exam and the Annual Wellness Visit March 28, 2012 1 Today s Panel of Experts Jamie Hermansen Health Insurance Specialist

More information

Medicaid National Correct Coding Initiative. Edit Design Manual. Page 1 of 54

Medicaid National Correct Coding Initiative. Edit Design Manual. Page 1 of 54 Medicaid National Correct Coding Initiative Edit Design Manual 2015 1/27/2015 Page 1 of 54 ` TABLE OF CONTENTS File Types... 4 MII Files File Formats... 4 Publication Files File Formats... 4 File Names...

More information

Modifier Magic 4/13/2015. Modifiers. Anatomical Modifiers. April 15, 2015 MMBA

Modifier Magic 4/13/2015. Modifiers. Anatomical Modifiers. April 15, 2015 MMBA Modifier Magic April 15, 2015 MMBA Modifiers Modifiers should be reported to bypass a clinical edit ONLY if the criteria for the use for the modifiers is met and supporting documentation is included in

More information

SAME DAY/SAME SERVICE

SAME DAY/SAME SERVICE SAME DAY/SAME SERVICE REIMBURSEMENT POLICY Policy Number: ADMINISTRATIVE 7. T0 Effective Date: June, 20 Table of Contents APPLICABLE LINES OF BUSINESS/PRODUCTS... APPLICATION... OVERVIEW... REIMBURSEMENT

More information

Oregon CO-OP Modifier Table - December 2013

Oregon CO-OP Modifier Table - December 2013 Oregon CO-OP Modifier Table - December 2013 Modifier Modifier Description Pricing Functionality 22 Increased Procedural Services Modifier 22 should only be reported with procedure codes that have a global

More information

5/1/2015. Mary Ellen Duffy, MBA, FACMPE, CHBME

5/1/2015. Mary Ellen Duffy, MBA, FACMPE, CHBME Mary Ellen Duffy, MBA, FACMPE, CHBME 1 To crack down on the people and organizations who abuse the system and cost Americans billions of dollars each year. Detroit: 2013 brought charges in fraud schemes

More information

CONNECTIONS TESTING FOR ICD-10

CONNECTIONS TESTING FOR ICD-10 TESTING FOR ICD-10 In conjunction with the Centers for Medicare and Medicaid Services (CMS), Providence Health Plan (PHP) and all major payers will convert from International Classification of Diseases,

More information

Billing an NP's Service Under a Physician's Provider Number

Billing an NP's Service Under a Physician's Provider Number 660 N Central Expressway, Ste 240 Plano, TX 75074 469-246-4500 (Local) 800-880-7900 (Toll-free) FAX: 972-233-1215 info@odellsearch.com Selection from: Billing For Nurse Practitioner Services -- Update

More information

ANESTHESIA - Medicare

ANESTHESIA - Medicare ANESTHESIA - Medicare Policy Number: UM14P0008A2 Effective Date: August 19, 2014 Last Reviewed: January 1, 2016 PAYMENT POLICY HISTORY Version DATE ACTION / DESCRIPTION Version 2 January 1, 2016 Under

More information

Corporate Reimbursement Policy

Corporate Reimbursement Policy Corporate Reimbursement Policy Code Bundling Rules Not Addressed in ClaimCheck or Correct Coding Initiative File Name: code_bundling_rules_not_addressed_in_claim_check Origination: 6/2004 Last Review:

More information

ILLINOIS WORKERS' COMPENSATION COMMISSION MEDICAL FEE SCHEDULE INSTRUCTIONS AND GUIDELINES

ILLINOIS WORKERS' COMPENSATION COMMISSION MEDICAL FEE SCHEDULE INSTRUCTIONS AND GUIDELINES Table of Contents ILLINOIS WORKERS' COMPENSATION COMMISSION MEDICAL FEE SCHEDULE INSTRUCTIONS AND GUIDELINES For treatment before 2/1/09 Introduction and Purpose Reference Materials Section 1. Ambulatory

More information

MEDICARE TEACHING PHYSICIAN QUESTIONS & ANSWERS December 2003

MEDICARE TEACHING PHYSICIAN QUESTIONS & ANSWERS December 2003 MEDICARE TEACHING PHYSICIAN QUESTIONS & ANSWERS December 2003 In November 2002 CMS issued revisions to the Carrier Manual Instructions, section 15016, Supervising Physicians in Teaching Settings. To help

More information

US Reimbursement Guide

US Reimbursement Guide US Reimbursement Guide The information with this notice is general reimbursement information only. It is not legal advice, nor is it about how to code, complete or submit any particular claim for payment.

More information

Understanding Modifiers

Understanding Modifiers Optum360 Learning www.optumcoding.com Understanding Modifiers Comprehensive instruction to effective modifier application 2017 a ICD-10 A full suite of resources including the latest code set, mapping

More information

Chronic Care Management (CCM) Services. Presented by Noridian Part B Medicare Provider Outreach and Education December 2015

Chronic Care Management (CCM) Services. Presented by Noridian Part B Medicare Provider Outreach and Education December 2015 Chronic Care Management (CCM) Services Presented by Noridian Part B Medicare Provider Outreach and Education December 2015 DISCLAIMER This information release is the property of Noridian Healthcare Solutions,

More information

Anesthesia Services. UnitedHealthcare Medicare Reimbursement Policy Committee

Anesthesia Services. UnitedHealthcare Medicare Reimbursement Policy Committee Anesthesia Services Policy Number ANES08272009RP Approved By UnitedHealthcare Medicare Committee Current Approval Date 08/27/2014 IMPORTANT NOTE ABOUT THIS REIMBURSEMENT POLICY This policy is applicable

More information

Reimbursement Policy. Policy

Reimbursement Policy. Policy Reimbursement Policy Subject: Modifier Usage Effective Date: 03/14/13 Committee Approval Obtained: 09/22/14 Section: Coding These policies serve as a guide to assist you in accurate claim submissions and

More information

Diabetes Outpatient Self-Management Training (NCD 40.1)

Diabetes Outpatient Self-Management Training (NCD 40.1) Policy Number 40.1 Approved By UnitedHealthcare Medicare Reimbursement Policy Committee Current Approval Date 02/11/2015 IMPORTANT NOTE ABOUT THIS REIMBURSEMENT POLICY This policy is applicable to UnitedHealthcare

More information

BILLING AND CODING ISSUES FOR PHYSICIAN, NP, PA, CNS

BILLING AND CODING ISSUES FOR PHYSICIAN, NP, PA, CNS BILLING AND CODING ISSUES FOR PHYSICIAN, NP, PA, CNS Alva S. Baker, MD, CMD Objectives: Describe basic billing and coding practices applicable to long term care Delineate task performance in nursing homes

More information