Appropriate Modifier Usage

Size: px
Start display at page:

Download "Appropriate Modifier Usage"

Transcription

1 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 a procedure was performed at two separate and distinct anatomic sites. Examples of anatomical modifiers are: E1 E4, FA, F1 F9, TA, T1 T9, LT, RT, LC, LD and RC. Use of anatomical modifiers facilitates the identification of separate and distinct services. For example, a provider may report modifier F2 on one line and modifier F3 on another line when procedure code *26455 is reported as performed on each of those fingers, instead of reporting a count of two on one line. Anatomical modifiers should be reported instead of modifier 59, when possible. For example, if a provider performs foot surgery, reporting code *28285 and code *28292 at the same operative session but on different sites, anatomic modifiers should be appended to each line to indicate that the procedures performed were separate and distinct. 59 is to be used only when there are no other modifiers that accurately indicate the nature of the service performed. If an anatomical modifier is used and the modifier is not appropriate to the procedure code, the claim may be denied. Anesthesia claims must be reported with the appropriate modifier for the practitioner administering the anesthesia: AA, AD, QK or QY is reported for a physician who administers the anesthesia or who supervises its administration. QX or QZ is reported for a certified registered nurse anesthetist who administers the anesthesia. Services performed by CRNAs without the medical direction of an anesthesia physician are paid the charge or 85 percent of the maximum payment, whichever is lower. Anesthesia services performed by CRNAs or anesthesia assistants in physician offices are not eligible for payment. Non-end stage renal disease claims for the administration of erythropoiesis-stimulating agents must contain one of the current HCPCS modifiers: EA, EB or EC. Refer to the Claims chapter of the BCN Provider Manual for information on appropriate usage of the FB, FC and FD modifiers. Specifically, see the Reporting of medical device credits by hospital and ambulatory surgery centers subsection, which is in the Other billing and payment guidelines section of that chapter. 1

2 GN, GO and GP HA JA and JB JW A physical medicine and rehabilitation service must be reported with the appropriate therapy modifier indicating the discipline performing the therapy. The modifiers are GN, GO and GP. The codes requiring these modifiers include the following: *92507, *92508, *92521-*92524, *92526, *92597, * , *96125, *97001-*97004, *97010-*97012, *97014, *97016-*97028, *97032-*97039, * *97124, *97139-*97140, *97150, *97530, *97532-*97537, *97542, *97750, *97755, *97760-*97762, *97799, G0129, G0283, G0329, S8948, S8950, S9152 or S9476. If the procedure code is reported without the modifier, the service may be denied because the required modifier is missing. The reporting of these modifiers indicating the type of therapy performed does not supersede the provider s reimbursement arrangement with BCN for these services. Note: This information applies to all BCN products. The CPT codes *97597, *97598, *97602, *97605, *97606, G0281 and G0329 are classified by the CMS as sometimes therapy procedure codes. (Code G0329 is for BCN Advantage members only; it is not covered for BCN commercial members.) When these services are provided for active wound management, they should not be reported with therapy modifiers (GN, GO or GP) and/or revenue codes 0421/0424, 0431/0434 and 0441/0444, as these modifiers/revenue codes indicate therapy services. Reporting wound management procedure codes with revenue codes 0421/0424, 0431/0434 and 0441/0444, will result in the claim line for the procedure being denied. To receive the correct reimbursement, board-certified child and adolescent psychiatrists should bill with the HA modifier rather than the AM modifier. All claims with an HA modifier will be audited to ensure that only boardcertified child and adolescent psychiatrists are billing the HA modifier. When billing HCPCS codes Q4081, J0882 or J0886 for ESRD patients, it is required that the following modifiers be used: JA and JB. Note: Failure to follow these billing guidelines may result in the claim being returned unprocessed. JW may be used to identify drugs that are discarded or not used for a member. When reporting the modifier for drugs administered from a single-use vial or single-use package, providers should follow these guidelines: JW should not be reported when the billing unit is greater than the actual dose provided. For example, if the procedure code nomenclature for the drug is 10 mg but the dosage administered was 5 mg and the vial contains only 10 mg, then the unit reported on the claim would be 1 because the billing unit provides for full reimbursement of the 10-mg dosage. The modifier JW may be reported if the billing unit is less than the actual dose provided. For example, if the procedure code nomenclature for the drug is 1 mg but the dosage administered was 5 mg and the vial contains 10 mg, then two lines would be reported: o Line 1: Report the five units used. o Line 2: Report the five units discarded with the JW modifier. The JW modifier should be noted only on the line for the wasted drug. Note: Multi-dose vials should not be reported with the JW modifier. 2

3 24 24 is used to report a subsequent but unrelated E&M service performed during the global surgery period that should be evaluated separately. 25 When reporting an office/outpatient or inpatient consultation procedure code with a minor surgical procedure (0 or 10 day) performed on the same day, if the E&M service provided was distinct from the surgical procedure, it needs to be reported with modifier 25. If not reported with the modifier, the E&M visit may receive an edit indicating it was considered part of the global surgical package. Note: BCN audits health care practitioners who report modifier 25 at a rate much higher than their medical specialty peers. 25 should be used with E&M codes only and should not be appended to the code for the surgical procedure or other service (for example, therapeutic injections, therapeutic infusions or diagnostic X-rays or scans). Documentation must be maintained in the member s clinical record to substantiate the use of modifier 25. To document the extra work performed, the member s clinical record must clearly indicate the extra or unusual work. The documentation must support that the E&M service being billed is distinct from the other service performed. 50 When reporting services performed bilaterally, identify the procedure code with modifier 50 and a count of 1 on the claim line. For example, using modifier 50 would be an appropriate way to report a procedure done on the right wrist and the left wrist at the same setting, each with a count of 1. This is different than advice from some payers who request that a bilateral procedure be reported with one line with a modifier 50 and a second line with the same procedure code but without a modifier 50. Only if the procedure was performed twice on each wrist would it be appropriate to report the procedure code with a modifier 50 and a count of When modifier 52 is reported with a procedure code, reimbursement will be adjusted to 50 percent of the fee schedule. When modifier 52 is reported with a procedure code, reimbursement will be adjusted to 50 percent of the allowed amount. Note: This applies to BCN Advantage SM and BCN commercial products. 53 BCN reduces payment by 50 percent of the fee schedule for the procedure code billed with modifier , 55 and 56 A follow-up surgical procedure performed by an emergency room physician within 90 days of a surgical procedure done in an emergency room is typically reported with modifier 54, indicating that only preoperative and surgical care were provided. The member s own physician would be expected to assume the care of the member postoperatively. Claims for these followup surgical procedures will be sent back to the provider with instructions to resubmit. If surgical care is split between providers, the claims submitted should identify the care provided by use of the appropriate modifiers. The surgical care modifiers include modifiers 54, 55 and 56. Claim lines reported with these modifiers will be reimbursed according to the percentages from the national (CMS) Physician Fee Schedule Relative Value Files. 54 is reimbursed by CMS at the combined preoperative and intraoperative percentages. Note: This applies to BCN Advantage and BCN commercial products. 3

4 57 It is not appropriate to report modifier 57 for major surgeries that are planned in advance. When modifier 57 is reported with a procedure that falls within one of the categories of planned surgeries, the E&M service will be denied. The categories of planned surgeries include: Spine surgery, excluding fractures and dislocations Arthroplasty: total, partial and revision Congenital/deformity procedures (for example, clubfoot) Transplant procedures Chronic/subacute conditions (for example, tennis elbow or cataract surgery) 57 should not be used with E&M services performed on the same day as minor surgical procedures is used to indicate that a subsequent procedure performed during the global surgery period was anticipated. The global surgery period is defined according to CMS guidelines and incorporates the postoperative time frames of 0, 10 and 90 days. Medical services performed in the postoperative period that are associated with an earlier surgery must be appropriately coded with modifier 58 to avoid unnecessary editing may be appended when procedures not typically reported together needed to be performed on a patient on the same day by the same physician, such as separate incisions or procedures done on different organ systems. 59 should not be used unless other modifiers do not apply. 59 is not required to override the edit between procedure code *11100 and any of the following codes: *11040-*11042, *11055-*11057, *11200, *11300-*11301, *11305, *11307, *11310, *16000, *16020, *17000, *17250 and * Reporting modifier 59 with *11100 and any of these codes could result in an incorrect reduction in reimbursement. Procedure code *11100 and any of the listed codes will process without a modifier. (This applies to all BCN products except BCN Advantage and BCN 65.) Note: Reporting of other codes with any of the noted combinations could affect clinical editing results. When reporting another injection along with an immunization, you must report modifier 59 on the injection procedure. If both services are provided and modifier 59 is not indicated, an edit may occur between the injection administration code and the immunization administration code. For its commercial membership, BCN recognizes modifier 59 as valid but does not allow it to automatically override all edits allowed in the National Correct Coding Initiative Manual. The codes for which modifier 59 will override appropriate edits and increase payment are listed in the Addendum in this document. (The Addendum applies to all BCN products except BCN Advantage and BCN 65. For BCN Advantage, the CMS listing is followed.) Note: The Medicare Learning Network publishes a comprehensive article on the correct use of modifier 59 in MLN Matters Number: SE0715 at cms.gov/mlnmattersarticles. 73 and 74 When a surgical or diagnostic procedure is discontinued, modifier 73 or 74 is required in order to administer payment appropriately. 73 is reported when the surgical or diagnostic procedure was discontinued before the anesthesia was administered. 74 is reported when the surgical or diagnostic procedure was discontinued after the anesthesia was administered. 4

5 76 and 77 s 76 and 77 can be used for codes *70010-*79999, *88104-*88199, *88300-*88399, *93000, *93005, *93010 and *93040-* can also be used for code * These are the only codes with which these modifiers can be used. When reporting repeat radiology, EKG or surgical pathology procedures with modifier 76 or 77, follow these guidelines: Claims with the initial service (those that would not require a modifier) should be reported before the repeat services (those with modifier 76 or 77) are reported. Subsequent services are to be reported with the appropriate modifier. Use modifier 76 if the procedure is repeated by the same physician; use modifier 77 if a different physician does the procedure. Reporting the initial service (without a modifier) after the subsequent service (those with the modifier) could result in a denial of the initial service. When it is not clear which claim will come into the system first, it is acceptable to report modifier 76 or 77 on the initial line as well to facilitate claims processing. Note: This applies to BCN Advantage and BCN commercial products is used to indicate return trips to the operating room during the global surgery period for complications related to an earlier procedure. The global surgery period is defined according to CMS guidelines, incorporating the postoperative time frames of 0, 10 and 90 days. Medical services performed after an earlier surgery that are unintended or unexpected must be appropriately coded using modifier 78 to avoid unnecessary editing. For procedures with a 10- or 90-day global period, the procedure reported with modifier 78 is reimbursed on the value of the intraoperative care, as noted in the Medicare Fee Schedule. Procedures that have a 0-day global period reported with modifier 78 are not subject to this adjustment. Note: This applies to BCN Advantage and BCN commercial products is used to indicate that a subsequent procedure performed during the global surgery period should be evaluated separately. The global surgery period is defined according to CMS guidelines, incorporating the postoperative time frames of 0, 10 and 90 days. Medical services performed during the postoperative period that are not associated with the earlier surgery must be appropriately coded using modifier 79 to avoid unnecessary editing is used for laboratory tests in the pathology and laboratory code range (*80000 series). 5

6 ADDENDUM The following table lists CPT codes for which modifier 59 impacts payment. *10021 *10022 CPT codes for which modifier 59 impacts payment Note: This addendum applies to BCN commercial products only. *11042 *11043 *11044 *11055 *11056 *11057 *11100 *11101 *11200 *11201 *11400 *11401 *11402 *11403 *11404 *11406 *11420 *11421 *11422 *11423 *11440 *11441 *11442 *11443 *11600 *11601 *11602 *11603 *11604 *11606 *11730 *11732 *11900 *11901 *11970 *12001 *12002 *12004 *12005 *12006 *12007 *12011 *12013 *12014 *12015 *12016 *12017 *12018 *12031 *12032 *12034 *12035 *12036 *12041 *12042 *14000 *14001 *14020 *14021 *14040 *14041 *14060 *14061 *14350 *17000 *17003 *17110 *17250 *19000 *19001 *19100 *19101 *19102 (a) *19103 (a) *19120 *20600 *20605 *20610 *20670 *20680 *20937 *23130 *24357 *24358 *24359 *26180 *27438 *27640 *27641 *27685 *27686 *28104 *28106 *28107 *28120 *28122 *28230 *28232 *28234 *28288 *29075 *29405 *29540 *29580 *29819 *29871 *29873 *29874 *29875 *29876 *29877 *29879 *29880 *29881 *29882 *29883 *29894 *29895 *29897 *29898 *29899 *30130 *30140 *30801 *30802 *30930 *31515 *31520 *31525 *31526 *31527 *31528 *31529 *31575 *31576 *31577 *31578 *33530 *34001 *34203 *35226 *35646 (a) Code ended 12/31/13. 6

7 CPT codes for which modifier 59 impacts payment Note: This addendum applies to BCN commercial products only. *36005 *36014 *36215 *36216 *36217 *36218 *36245 *36246 *36247 *36248 *36410 *36415 *38500 *38525 *38745 *43255 *43268 (a) *45379 *45380 *45381 *45382 *45383 *45384 *45385 *45386 *45387 *47100 *49560 *49561 *49565 *49566 *49568 *49570 *49572 *49580 *49582 *49585 *49587 *52281 *53020 *54161 *55700 *55705 *56700 *57061 *57065 *57170 *58120 *58300 *58301 *63020 *63030 *63035 *63042 *63047 *63048 *63075 *63076 *64716 *64718 *64719 *64721 *64722 *64726 *67250 *67255 *69210 *69310 *71010 *72020 *72275 *73100 *73110 *73120 *73130 *73590 *73592 *73620 *73630 *74000 *74010 *74020 *74022 *74150 *74160 *74170 *76380 *76805 *76810 *76816 *76830 *76856 *76857 *78481 *78483 *80053 *81015 (a) Code ended 12/31/13. 7

8 *84443 *85025 *85027 CPT codes for which modifier 59 impacts payment Note: This addendum applies to BCN commercial products only. *90772 *90773 *90774 *90775 *90779 *90862 (b) *93000 *93005 *93010 *93040 *93041 *93312 *93313 *93314 *94002 *94003 *94004 *94005 *95120 *95125 *95130 *95131 *95132 *95133 *95134 *95870 *96372 *96373 *96374 *96375 *96376 *96379 Note: BCN reserves the right to audit claims, including those submitted with modifier 59, to ensure compliance with BCN s utilization management and claim guidelines. Payment for multiple surgeries applies when two surgery codes are billed on the same claim. (b) Code ended 12/31/12. 8

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

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

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

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

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

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

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

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

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

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

CPT/HCPCS Modifiers. [Refer to WAC 182-531-1850(10) and (11)] Italics indicate additional Agency language not found in CPT.

CPT/HCPCS Modifiers. [Refer to WAC 182-531-1850(10) and (11)] Italics indicate additional Agency language not found in CPT. CPT/HCPCS Modifiers [Refer to WAC 182-531-1850(10) and (11)] Italics indicate additional Agency language not found in CPT. 22: Unusual Procedural Services: When the service(s) provided is greater than

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

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

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

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

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

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

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

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

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

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

AUTHORIZED MODIFIERS. Updated: 01/16/2015

AUTHORIZED MODIFIERS. Updated: 01/16/2015 AUTHORIZED MODIFIERS Updated: 01/16/2015 A modifier provides the means for a provider to indicate that a service or procedure was altered by a specific circumstance but not changed in its definition or

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

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

There are four anesthesia categories as determined by CMS that affect payment of anesthesia services based on the provider rendering the services:

There are four anesthesia categories as determined by CMS that affect payment of anesthesia services based on the provider rendering the services: PROVIDER BILLING GUIDELINES Anesthesia Background Qualified medical professionals administer anesthesia to relieve pain while at the same time monitoring and controlling the patients health and vital bodily

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

Published January 2011. Part B

Published January 2011. Part B Published January 2011 Part B IMPORTANT The information provided in this manual was current as of November 2010. Any changes or new information superseding the information in this manual, provided in newsletters/ebulletins,

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

Reimbursement Policy. Subject: Professional Anesthesia Services

Reimbursement Policy. Subject: Professional Anesthesia Services Reimbursement Policy Subject: Professional Anesthesia Services Effective Date: 01/01/15 Committee Approval Obtained: 01/01/15 Section: Anesthesia ***** The most current version of our reimbursement policies

More information

Pennsylvania Workers Compensation Billing Tutorial. Step 1: Find the Charge Classes by Zip Code

Pennsylvania Workers Compensation Billing Tutorial. Step 1: Find the Charge Classes by Zip Code Step 1: Find the Charge Classes by Zip Code http://www.portal.state.pa.us/portal/server.pt/community/charge_classes_by_zip_co de/10428 The Pennsylvania Workers' Compensation Fee Schedule for Part B providers

More information

Anesthesia Guidelines

Anesthesia Guidelines Anesthesia Guidelines Updated April 2012 Anesthesia BlueCross requires anesthesiologists and certified registered nurse anesthetists (CRNAs) to file claims using CPT anesthesia codes. We cover general

More information

Status Active. Reimbursement Policy Section: Anesthesia Services Policy Number: RP - Anesthesia - 001 Anesthesia Effective Date: June 1, 2015

Status Active. Reimbursement Policy Section: Anesthesia Services Policy Number: RP - Anesthesia - 001 Anesthesia Effective Date: June 1, 2015 Status Active Reimbursement Policy Section: Anesthesia Services Policy Number: RP - Anesthesia - 001 Anesthesia Effective Date: June 1, 2015 Anesthesia Policy Description: Definitions: This policy addresses

More information

IMPORTANT NOTICE REGARDING NEW ANESTHESIA BILLING GUIDELINES AND REIMBURSEMENT PROCEDURES. February 2010

IMPORTANT NOTICE REGARDING NEW ANESTHESIA BILLING GUIDELINES AND REIMBURSEMENT PROCEDURES. February 2010 IMPORTANT NOTICE REGARDING NEW ANESTHESIA BILLING GUIDELINES AND REIMBURSEMENT PROCEDURES February 2010 This notice will serve as an update to the November 2008 Anesthesia Billing Guidelines and Reimbursement

More information

CUSTOM SOFTWARE SYSTEMS, INC

CUSTOM SOFTWARE SYSTEMS, INC MODIFIERS 4 21 PROLONGED EVALUATION AND MANAGEMENT SERVICES 5 22 UNUSUAL PROCEDURAL SERVICES 6 23 UNUSUAL ANESTHESIA 7 24 UNRELATED EVALUATION AND MANAGEMENT SERVICE BY THE SAME PHYSICIAN DURING A POSTOPERATIVE

More information

Anesthesia Payment & Billing Information

Anesthesia Payment & Billing Information Anesthesia Payment & Billing Information Time and Points Eligible Anesthesia Procedures Defined HMO Blue Texas SM and Blue Cross and Blue Shield of Texas have determined that certain anesthesia procedures

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

The ASA defines anesthesiology as the practice of medicine dealing with but not limited to:

The ASA defines anesthesiology as the practice of medicine dealing with but not limited to: 1570 Midway Pl. Menasha, WI 54952 920-720-1300 Procedure 1205- Anesthesia Lines of Business: All Purpose: This guideline describes Network Health s reimbursement of anesthesia services. Procedure: Anesthesia

More information

What You Need to Know About Anesthesia Filing Guidelines

What You Need to Know About Anesthesia Filing Guidelines What You Need to Know About Anesthesia Filing Guidelines 2015 Edition Published by Provider Relations and Education Your Partners in Outstanding Quality, Satisfaction and Service This document provides

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

Modifiers 25 and 59. Modifier 25

Modifiers 25 and 59. Modifier 25 Modifiers 25 and 59 This article discusses the appropriate use of modifier 25, Significant, Separately Identifiable Evaluation and Management Service by the Same Physician on the Same Day of the Procedure

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

Table of Contents A. General Billing Information.3 B. Reimbursement Guidelines...5 C. Documentation for Anesthesia Record...9

Table of Contents A. General Billing Information.3 B. Reimbursement Guidelines...5 C. Documentation for Anesthesia Record...9 ANESTHESIA BILLING AND REIMBURSEMENT POLICY Payment policies apply to all in-network and out-of-network providers who render services to Neighborhood Health Plan of Rhode Island subscribers covered under

More information

Modifiers and all you will need to know!

Modifiers and all you will need to know! Modifiers and all you will need to know! 24Unrelated Evaluation and Management Service by the Same Physician during a Postoperative Period: The physician may need to indicate that an evaluation and management

More information

Anesthesia Processing Manual

Anesthesia Processing Manual Anesthesia Processing Manual Important Information The following disclaimer is applicable to all telephone inquiries and automated communications systems (i.e., telephone and fax) to Blue Cross and Blue

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

Modifiers. Disclaimer

Modifiers. Disclaimer Modifiers The Rest of the Story 1 Disclaimer This is not an all inclusive list of every modifier; this is an overview of many modifiers and their intended usage. This material is designed to offer basic

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

Medicare Physician Fee Schedule Modifiers

Medicare Physician Fee Schedule Modifiers Basics of MPFS Part 3 Medicare Physician Fee Schedule Modifiers Presented by Part B Provider Outreach and Education July 16, 2013 Disclaimer This information released is the property of Cahaba GBA and

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

Prerequisites. Authorization, Notification and Referral. Limitations ANESTHESIA SERVICES

Prerequisites. Authorization, Notification and Referral. Limitations ANESTHESIA SERVICES ANESTHESIA SERVICES Policy NHP reimburses participating providers for the administration of general and regional anesthesia, and supportive services performed in conjunction with covered obstetrical, surgical,

More information

CPT Coding in Oral Medicine

CPT Coding in Oral Medicine CPT Coding in Oral Medicine CPT - Current Procedural Terminology Medical Code Set (00000-99999) Established as an indexing/coding system to standardize terminology among physicians and other providers

More information

IWCC 50 ILLINOIS ADMINISTRATIVE CODE 7110 7110.90. Section 7110.90 Illinois Workers' Compensation Commission Medical Fee Schedule

IWCC 50 ILLINOIS ADMINISTRATIVE CODE 7110 7110.90. Section 7110.90 Illinois Workers' Compensation Commission Medical Fee Schedule Section 7110.90 Illinois Workers' Compensation Commission Medical Fee Schedule a) In accordance with Sections 8(a), 8.2 and 16 of the Workers' Compensation Act [820 ILCS 305/8(a), 8.2 and 16] (the Act),

More information

Coding with the CPT. By: Amber M. Baylor, M.S.

Coding with the CPT. By: Amber M. Baylor, M.S. Coding with the CPT By: Amber M. Baylor, M.S. Before You Begin It is advised that you purchase the most up-to-date CPT code book before watching this movie Outline History of the CPT Who uses CPT Coding?

More information

Coding Modifiers Table

Coding Modifiers Table Updated 07/12 Coding Modifiers Table The following chart has been developed to assist providers in understanding how the Kansas Medical Assistance Program (KMAP) handles specific modifiers. It is imperative

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

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

Modifier Reference Guide

Modifier Reference Guide General Instructions Ranking Modifiers Modifier Categories Modifier Reference Guide A. Pricing Modifiers B. Statistical Modifiers that Affect Pricing C. Statistical / Informational Modifiers Level I -

More information

Anesthesia Services INDIANA HEALTH COVERAGE PROGRAMS. Copyright 2016 Hewlett Packard Enterprise Development LP

Anesthesia Services INDIANA HEALTH COVERAGE PROGRAMS. Copyright 2016 Hewlett Packard Enterprise Development LP INDIANA HEALTH COVERAGE PROGRAMS PROVIDER REFERENCE M ODULE Anesthesia Services 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 9 P U B L I S H E D : F E B R U A R Y 25, 2 0 1 6 P O L

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

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

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

Anesthesia Policy. Approved By 3/11/2015

Anesthesia Policy. Approved By 3/11/2015 Anesthesia Policy Policy Number 2015R0032D Annual Approval Date 3/11/2015 Approved By Payment Policy Oversight Committee IMPORTANT NOTE ABOUT THIS REIMBURSEMENT POLICY You are responsible for submission

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

STATE OF NEVADA DEPARTMENT OF BUSINESS & INDUSTRY DIVISION OF INDUSTRIAL RELATIONS WORKERS COMPENSATION SECTION

STATE OF NEVADA DEPARTMENT OF BUSINESS & INDUSTRY DIVISION OF INDUSTRIAL RELATIONS WORKERS COMPENSATION SECTION STATE OF NEVADA DEPARTMENT OF BUSINESS & INDUSTRY DIVISION OF INDUSTRIAL RELATIONS WORKERS COMPENSATION SECTION NEVADA MEDICAL FEE SCHEDULE MAXIMUM ALLOWABLE PROVIDER PAYMENT February 1, 2012 through January

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

Office Managers Association at Presbyterian Hospital of Plano

Office Managers Association at Presbyterian Hospital of Plano Office Managers Association at Presbyterian Hospital of Plano Update your charge slips annually Team approach Pain management example Grace period discontinued! New CPT, HCPCS and ICD-9 codes Changed definitions

More information

BCBSMA Processing Guidelines for CPT Modifiers

BCBSMA Processing Guidelines for CPT Modifiers BCBSMA Processing Guidelines for CPT Modifiers In accordance with the implementation of the Health Insurance Portability and Accountability Act (HIPAA), if you currently use modifiers in your billing it

More information

SECTION 4. A. Balance Billing Policies. B. Claim Form

SECTION 4. A. Balance Billing Policies. B. Claim Form SECTION 4 Participating Physicians, hospitals and ancillary providers shall be entitled to payment for covered services that are provided to a DMC Care member. Payment is made at the established and prevailing

More information

MEDICAL ASSISTANCE BULLETIN

MEDICAL ASSISTANCE BULLETIN ISSUE DATE September 12, 2014 SUBJECT EFFECTIVE DATE September 15, 2014 MEDICAL ASSISTANCE BULLETIN NUMBER 99-14-08 BY Implementation of National Correct Coding Initiative Related Modifiers Vincent D.

More information

Part A Modifiers Part Two. Presented by Provider Outreach and Education April 2016

Part A Modifiers Part Two. Presented by Provider Outreach and Education April 2016 Part A Modifiers Part Two Presented by Provider Outreach and Education April 2016 DISCLAIMER This information release is the property of Noridian Healthcare Solutions, LLC. It may be freely distributed

More information

Inpatient Services. Guide to Billing Facility Services. November 2013. Preface. Summary of Changes. Table of Contents.

Inpatient Services. Guide to Billing Facility Services. November 2013. Preface. Summary of Changes. Table of Contents. Inpatient Services Preface Summary of Changes Table of Contents Service Contacts November 2013 Replaces: December 2012 S-5781 11/13 Preface The Wellmark Provider Guide and specialty guides are billing

More information

Modifiers. Hoda Henein, CHBME, CP President & CEO, Active Management A Practice Management Consulting and Billing Company

Modifiers. Hoda Henein, CHBME, CP President & CEO, Active Management A Practice Management Consulting and Billing Company Modifiers Hoda Henein, CHBME, CP President & CEO, Active Management A Practice Management Consulting and Billing Company Fellow, Speaker, Billing & Coding Advisor American Academy of Podiatric Practice

More information

NOTE: Should you have landed here as a result of a search engine (or other) link, be advised that these files contain material that is copyrighted by

NOTE: Should you have landed here as a result of a search engine (or other) link, be advised that these files contain material that is copyrighted by NOTE: Should you have landed here as a result of a search engine (or other) link, be advised that these files contain material that is copyrighted by the American Medical Association. You are forbidden

More information

Ambulatory Surgery Center (ASC)

Ambulatory Surgery Center (ASC) Ambulatory Surgery Center (ASC) Table of Contents: Overview... 1 Billing Guidelines... 1 Reimbursement... 2 Bilateral Surgeries Performed in an ASC... 3 Supplies/Devices/Implants Paid in Addition to the

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

r JOHNS HOPKINS HEALTHCARE Physician Guidelines Subject: Anesthesia Processing Guidelines Lines of Business: EHP, USFHP, Priority Partners

r JOHNS HOPKINS HEALTHCARE Physician Guidelines Subject: Anesthesia Processing Guidelines Lines of Business: EHP, USFHP, Priority Partners Revision Date: 11/14/14 Last Reviewed Date: 11/14/14 Page 1 of 7 ACTION New Procedure Amending Procedure Number: Superseding Procedure Number: Repealing Procedure Number: REFERENCES: AMPT Committee ASA

More information

The Impact of Modifiers. By: Rhonda Granja, B.S.,CMA, CMC, CPC, CMOM

The Impact of Modifiers. By: Rhonda Granja, B.S.,CMA, CMC, CPC, CMOM The Impact of Modifiers By: Rhonda Granja, B.S.,CMA, CMC, CPC, CMOM A modifier provides the means to report or indicate that a service or procedure that has been performed has been altered by some specific

More information

Ingenix Coding Lab: Understanding Modifiers

Ingenix Coding Lab: Understanding Modifiers Ingenix Coding Lab: Understanding Modifiers Contents Contents Introduction...1 What Are HCPCS Modifiers?... 1 Outpatient Modifier Guidelines/Usage... 3 Modifiers and CPT Section to Which They Apply...

More information

Applying Modifiers. Applying Modifiers

Applying Modifiers. Applying Modifiers $traight Talk XXII November 11, 2013 Sandy Steele, CPC, CPMA, CEDC, CAC What is a Modifier? A modifier added to a CPT code will help provide additional information on the claim. A modifier can help answer

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

UNDERSTANDING & CODING WITH MODIFIERS

UNDERSTANDING & CODING WITH MODIFIERS UNDERSTANDING & CODING WITH MODIFIERS -21 Prolonged Evaluation and Management When the service provided is prolonged or otherwise greater than that usually required for the highest level of service in

More information

Modifiers The Key To Proper Reimbursement. Proper use of modifiers (usually) leads to correct payment. Author: Kenneth F. Malkin, D.P.M.

Modifiers The Key To Proper Reimbursement. Proper use of modifiers (usually) leads to correct payment. Author: Kenneth F. Malkin, D.P.M. Modifiers The Key To Proper Reimbursement Proper use of modifiers (usually) leads to correct payment. Author: Kenneth F. Malkin, D.P.M. Dr. Malkin is a diplomate of the American Board of Quality Assurance

More information

Anesthesia Policy Annual Approval Date

Anesthesia Policy Annual Approval Date Policy Number 2016R0032B Anesthesia Policy Annual Approval Date 3/11/2015 Approved By REIMBURSEMENT POLICY CMS-1500 Payment Policy Oversight Committee IMPORTANT NOTE ABOUT THIS REIMBURSEMENT POLICY You

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

Preface. Summary of Changes. Table of Contents. Service Contacts. October 2014 Replaces: May 2014 S-5781 10/14

Preface. Summary of Changes. Table of Contents. Service Contacts. October 2014 Replaces: May 2014 S-5781 10/14 Preface Summary of Changes Table of Contents Service Contacts October 2014 Replaces: May 2014 S-5781 10/14 Preface The Wellmark Provider Guide and specialty guides are billing resources for providers doing

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

The Global Surgery Package Part I. Riva Lee Asbell

The Global Surgery Package Part I. Riva Lee Asbell The Global Surgery Package Part I Riva Lee Asbell Introduction One of the least understood concepts in surgical coding concerns the details involved in the Global Surgery Package. Some of the rules were

More information

Reporting Hospital Outpatient Modifiers

Reporting Hospital Outpatient Modifiers Reporting Hospital Outpatient Modifiers Audio Seminar/Webinar April 17, 2008 Copyright 2008 American Health Information Management Association. All rights reserved. Disclaimer The American Health Information

More information

Modifier -25 Significant, Separately Identifiable E/M Service

Modifier -25 Significant, Separately Identifiable E/M Service Manual: Policy Title: Reimbursement Policy Modifier -25 Significant, Separately Identifiable E/M Service Section: Modifiers Subsection: None Date of Origin: 1/1/2000 Policy Number: RPM028 Last Updated:

More information

SUBCHAPTER 29. MEDICAL FEE SCHEDULES: AUTOMOBILE INSURANCE PERSONAL INJURY PROTECTION AND MOTOR BUS MEDICAL EXPENSE INSURANCE COVERAGE

SUBCHAPTER 29. MEDICAL FEE SCHEDULES: AUTOMOBILE INSURANCE PERSONAL INJURY PROTECTION AND MOTOR BUS MEDICAL EXPENSE INSURANCE COVERAGE SUBCHAPTER 29. MEDICAL FEE SCHEDULES: AUTOMOBILE INSURANCE PERSONAL INJURY PROTECTION AND MOTOR BUS MEDICAL EXPENSE INSURANCE COVERAGE 11:3-29.1 Purpose and scope (a) This subchapter implements the provisions

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

NEW YORK STATE MEDICAID PROGRAM PHYSICIAN PROCEDURE CODES. SECTION 2 MEDICINE, DRUGS and DRUG ADMINISTRATION

NEW YORK STATE MEDICAID PROGRAM PHYSICIAN PROCEDURE CODES. SECTION 2 MEDICINE, DRUGS and DRUG ADMINISTRATION NEW YORK STATE MEDICAID PROGRAM PHYSICIAN PROCEDURE CODES SECTION 2 MEDICINE, DRUGS and DRUG ADMINISTRATION Table of Contents GENERAL RULES AND INFORMATION... 3 MMIS MODIFIERS... 15 EVALUATION AND MANAGEMENT

More information

Chargemaster Nuts and Bolts. By Cathy Meeter, R.N. BSN CMAS CDM Director, Sutter Health

Chargemaster Nuts and Bolts. By Cathy Meeter, R.N. BSN CMAS CDM Director, Sutter Health Chargemaster Nuts and Bolts By Cathy Meeter, R.N. BSN CMAS CDM Director, Sutter Health Disclaimer The comments expressed throughout this presentation are my opinions, predicated on my interpretation of

More information

CODING. Neighborhood Health Plan 1 Provider Payment Guidelines

CODING. Neighborhood Health Plan 1 Provider Payment Guidelines CODING Policy The terms of this policy set forth the guidelines for reporting the provision of care rendered by NHP participating providers, including but not limited to use of standard diagnosis and procedure

More information

SECTION 5 HOSPITAL SERVICES. Free-Standing Ambulatory Surgical Center

SECTION 5 HOSPITAL SERVICES. Free-Standing Ambulatory Surgical Center SECTION 5 HOSPITAL SERVICES Table of Contents 1 GENERAL POLICY... 2 1-1 Clients Enrolled in a Managed Care Plan... 3 1-2 Clients NOT Enrolled in a Managed Care Plan (Fee-for-Service Clients)..................

More information

PART B MEDICARE. Modifier Billing Guide June 2011. NHIC, Corp. RT B. REF-EDO-0058 Version 4.0

PART B MEDICARE. Modifier Billing Guide June 2011. NHIC, Corp. RT B. REF-EDO-0058 Version 4.0 MEDICARE PART B RT B Modifier Billing Guide June 2011 NHIC, Corp. NHIC, Corp. 2 June 2011 Table of Contents Introduction... 6 General information... 7 WHAT ARE MODIFIERS?... 7 AMBULANCE... 8 AMBULATORY

More information

Don t Let Money Go to Waste. Learn to Bill Discarded Drugs Correctly.

Don t Let Money Go to Waste. Learn to Bill Discarded Drugs Correctly. Don t Let Money Go to Waste. Learn to Bill Discarded Drugs Correctly. The Centers for Medicare & Medicaid Services (CMS) recently released Transmittal 1962 clarifying the use of modifier JW and how to

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

Regulatory Compliance Policy No. COMP-RCC 4.07 Title:

Regulatory Compliance Policy No. COMP-RCC 4.07 Title: I. SCOPE: Regulatory Compliance Policy No. COMP-RCC 4.07 Page: 1 of 7 This policy applies to (1) any Hospital in which Tenet Healthcare Corporation or an affiliate owns a direct or indirect equity interest

More information