Modifier 59 (2021)

Modifier 59 (2021)

When you have distinct, separate procedures, know which modifiers will get the claim paid in full.Modifier 59 Distinct procedural service acts as a “universal unbundling” modifier for procedures that are normally included as part of another procedure, or “bundled.” The modifier tells the payer that there are special circumstances that warrant separate reporting (and payment) of the unbundled code.Special…

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…

Modifier QQ (2021)

Modifier QQ (2021)

Description: Ordering Professional Consulted A Qualified Clinical Decision Support Mechanism For This Service And The Related Data Was Provided To The Furnishing Professional. Effective date: July 1, 2018 Usage and guidelines: Used when the furnishing professional is aware of the result of the ordering professional’s consultation with a CDSM for that patient. Reported on the same…

Modifier X1-X5 (2021)

Modifier X1-X5 (2021)

Beginning Jan. 1, 2018, clinicians may report on Medicare Part B claims submitted for items and services the applicable HCPCS Level II modifiers established for patient relationship categories. Although the use and selection of these modifiers are not be a condition of payment, yet, clinicians should prepare for the likelihood of them becoming applicable components…

Modifiers for 340B-acquired drugs

Modifiers for 340B-acquired drugs

Information for the 340B Modifier – CMS established two Healthcare Common Procedure Coding System (HCPCS) Level II modifiers to identify 340B-acquired drugs: 340B Modifier “JG” Drug or biological acquired with 340B drug pricing program discount. 340B Modifier “TB” Drug or biological acquired with 340B drug pricing program discount, reported for informational purposes. When applicable, providers…

X{EPSU} Modifiers

The Medicare National Correct Coding Initiative (NCCI) has Procedure to Procedure (PTP) edits to prevent unbundling of services, and the consequent overpayment to physicians and outpatient facilities. The underlying principle is that the second code defines a subset of the work of the first code. Reporting the codes separately is inappropriate. Separate reporting would trigger…

Billing and coverage for drug wastage

Billing and coverage for drug wastage

Medicare Contractors will consider payment for unused and discarded portion of a single-use drug/biological product after administration of the appropriate (reasonable and necessary) dosage for the patient’s condition. This applies to drugs priced through the Average Sales Price (ASP) drug/biological program. The Centers for Medicare & Medicaid Services (CMS) encourages physicians, hospitals and other providers to provide injectable…