Proper Use of Modifier 50 (2021)

Proper Use of Modifier 50 (2021)

Novitas Solutions recently released a Modifier 50 Fact Sheet. It’s reminding to medical coders of the proper use for this CPT payment modifier.  The Medicare Administrative Contractor (MAC) for Jurisdictions H and L warns that, effective for Part B claims received on and after Aug. 16, 2019, services will be rejected as unprocessable when modifier…

Modifier 59 Changes in PTP edits

Modifier 59 Changes in PTP edits

Modification of the MCS Claims Processing System Logic for Modifier 59, XE Modifier, XS Modifier, XP Modifier, and XU Modifier Involving the National Correct Coding Initiative (NCCI) Procedure to Procedure (PTP) Column One and Column Two Codes. 59 Modifier, XE Modifier, XS Modifier, XP Modifier, and XU Modifier are among the NCCI-associated modifiers. The Multi-Carrier System…

New HCPCS Modifiers

New HCPCS Modifiers

HCPCS Modifiers List 2020: MA Ordering professional is not required to consult a clinical decision support mechanism due to service being rendered to a patient with a suspected or confirmed emergency medical conditionMB Ordering professional is not required to consult a clinical decision support mechanism due to the significant hardship exception of insufficient internet accessMC Ordering professional is…

United Healthcare Commercial Reimbursement Policy Updates effective from Sep 1st, 2019

United Healthcare Commercial Reimbursement Policy Updates effective from Sep 1st, 2019

Looking for the United healthcare physical therapy billing guidelines? The modifier “GN, GO or GP” will be required on Always for “Therapy codes” to align with the Centers for Medicare & Medicaid Services (CMS). According to CMS, certain codes are “Always Therapy” services regardless of who performs them, and always require a therapy modifier —…

Advanced Imaging Claims Require New Modifiers and G Codes

Advanced Imaging Claims Require New Modifiers and G Codes

From January 1, 2020, marks the start of the Appropriate Use Criteria (AUC) program educational and operations testing period, at which time Medicare Administrative Contractors (MACs) will begin accepting AUC related modifiers on claims for advanced diagnostic imaging services furnished to Medicare Part B patients. The voluntary participation period ends December 31, 2019. During this…

New Molecular Pathology Guidelines

New Molecular Pathology Guidelines

The new Molecular Pathology coding guidelines changes will be effective from dates of service on and after Sept. 1, 2019. American Medical Association (AMA) guidance provides Claim Designation codes in the Molecular Pathology coding guidelines Gene Table that represent specific genes that are being tested. UnitedHealthcare will require care providers to append the AMA Claim…

Modifier FY (2021)

Modifier FY (2021)

Beginning January 1, 2018, and including Calendar Years (CY) 2018-CY 2022, a payment reduction of 7 percent applies to the technical component (and the technical component of the global fee) for computed radiography services Similarly, if such X-ray services are furnished during CY 2023 or a subsequent year, a payment reduction of 10 percent applies…