Thursday, July 15, 2010

FB modifier

LEVEL II MODIFIER - FB

Description : Item Provided Without Cost to Provider, Supplier or Practitioner or a credit was received that covers the cost of the replaced device.

Required for Claims : Hospital Outpatient Claims subject to the Outpatient Prospective Payment System (OPPS)

Coding Guidelines :

1) Modifier –FB is used only when the manufacturer provides the item without cost or the hospital receives a full credit for the cost of the item.

2) Modifier –FB is always attached to the surgical procedure code, not the device code.

3) Modifier –FB should not be used when the hospital receives only a partial credit toward the cost of the item.

THE HOSPITAL MUST LOOK AT THE COST OF THE ITEM—NOT THE HOSPITAL’S CHARGE FOR THE ITEM.

General Guidelines :

Condition codes 49 & 50 are utilized to describe an item that is provided without cost to a provider, supplier or practitioner for use of items that are under warranty or defective:

49: Product Replacement within Product Life cycle
50: Product Replacement of a Known Recall of a Product

Use of HCPCS Modifier -FB

Effective January 1, 2007, the definition of modifier -FB is “Item Provided Without Cost to Provider, Supplier or Practitioner, or Credit Received for Replacement Device (Examples, but not Limited to: Covered Under Warranty, Replaced Due to Defect, Free Samples)”. See the Medicare Claims Processing Manual, Pub 100-04, Chapter 4, §61.3 for instructions regarding charges for items billed with the -FB modifier.

The OPPS hospitals must report modifier -FB on the same line as the procedure code (not the device code) for a service that requires a device for which neither the hospital, nor the beneficiary, is liable to the manufacturer. Hospitals must report modifier -FB on the same line as the procedure code for a service that requires a device when the manufacturer gives credit for a device being replaced with a more costly device.



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