Friday, May 7, 2010

Modifer 99 AND NU

DME MAC Jurisdiction C Modifier

CPT Modifier 99 – Multiple Modifiers

99 -- MODIFIER OVERFLOW. (EFFECTIVE DATE 7/1/2003)This modifier is used when you have exhausted the modifier field on the claim form. If you need additional room to add modifiers, append the 99 modifier to the last available field and include a narrative of other modifiers needed on the claim.

Under certain circumstances, two or more modifiers may be necessary to completely delineate a service. In such situations, CPT modifier 99 must be added to the basic procedure, and other applicable modifiers must be listed as part of the description of the service

Modifier -99 indicates that multiple modifiers may apply to a particular service. Because Blue Cross can accept up to four modifiers,  -99 should be used only if there are five or more modifiers applicable to a particular service line. In that circumstance, if -99 is submitted, the additional modifiers must be entered on the narrative record.

Impact of payment or adjudication may be based on what the additional modifier(s) represents.

Reporting on CMS 1500 ON BOX 19

Enter all applicable modifiers when modifier -99 (multiple modifiers) is entered in item 24d. If modifier -99 is entered on multiple line items of a single claim form, all applicable modifiers for each line item containing a -99 modifier should be listed as follows: 1=(mod), where the number 1 represents the line item and "mod" represents all modifiers applicable to the referenced line item.

Purchase Modifiers (Medicaid and Medicare)

NU -- NEW DURABLE MEDICAL EQUIPMENT PURCHASE.This modifier is used for new DME items that are purchased. When using the NU modifier, you are indicating you have furnished the beneficiary with a new (never used) piece of equipment.

The following modifiers indicate that an item has been purchased:

** NU New Equipment (use the NR modifier when DME which was new at the time of rental is subsequently purchased)
** UE Used Equipment
** NR New when rented
** KM Replacement of facial prosthesis including new impression/moulage
** KN Replacement of facial prosthesis using previous master model

NU, RR Modifiers 

NU and RR are only  considered valid modifiers for procedure codes (items) that can be either rented or purchased.

Modifiers NU and RR are used to clarify which method of use is being billed on a claim when the item is eligible for both rental and/or purchase (e.g. walker, crutches, standard wheelchairs, hospital bed). These are the only codes that will be allowed in combination with either NU or RR.

Do not use modifier NU for an item that cannot be rented.

If the item is always purchased, clarification with modifier NU is not needed. It is unnecessary and redundant to use modifier NU for items that are always purchased. The code should be reported without the unnecessary modifier.

Examples of items that are always purchased are: anything custommolded, any supplies, any one-patientonly items such as wrist/leg braces, etc. Procedure codes for these items should be reported without modifier NU.

EY -- NO PHYSICIAN OR OTHER LICENSED HEALTH CARE PROVIDER ORDER FOR THIS ITEM OR SERVICE. (EFFECTIVE DATE 1/1/2003) If you do not have a prescription from the physician prior to billing Medicare, you must append the EY modifier to your claim

BO -- ORALLY ADMINISTERED NUTRITION, NOT BY FEEDING TUBE. (EFFECTIVE DATE 1/1/2003)When enteral nutrients (B4149-B4162) are administered by mouth, the BO modifier must be added to the code.



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