Saturday, December 11, 2010

what is informational only modifiers

Informational Only Modifiers

The following modifiers are Informational Only and should be placed after all pricing modifiers. Modifier 99 has specific instructions on its own separate fact sheet.

AQ Services provided in a Health Professional Shortage Area (HPSA)

CB Services ordered by a dialysis facility physician as part of the ESRD beneficiary's dialysis benefit, is not part of the composite rate, and is separately reimbursable

CR Emergency health care needs of beneficiaries and providers affected by Hurricane Katrina and any future disasters

GA The provider or supplier has provided an Advance Beneficiary Notice of Noncoverage (ABN) to the patient and has a signed copy on file.

GN Services delivered under an outpatient speech-language pathology plan of care

GO Services delivered under an outpatient occupational therapy plan of care

GP Services delivered under an outpatient physical therapy plan of care

GV Attending physician not employed or paid under agreement by the patient's hospice provider.

GW Service not related to the hospice patient's terminal condition

GY Statutorily excluded service - If the service provided is statutorily excluded from the Medicare Program, the claim will deny whether or not the modifier is present on the claim.

GZ The provider or supplier expects a medical necessity denial; however, did not provide an Advance Beneficiary Notice of Noncoverage (ABN) to the patient.

QW CLIA waived test

Q5 Service furnished by a substitute physician under a reciprocal billing arrangement

Q6 Service furnished by a locum tenens physician

22 Increased Procedural Service requiring work substantially greater than typically required.

24 Unrelated evaluation and management (E/M) service by the same physician* during a postoperative period

25 Significant, separately identifiable evaluation and management (E/M) service by the same physician* on the day of a procedure

27 Multiple Outpatient Hospital E & M Encounters on the Same Date (This should not be submitted)

52 Reduced Service reports a partially reduced or eliminated service or procedure

57 Indicates an Evaluation and Management (E/M) service resulted in the initial decision to perform surgery either the day before a major surgery (90-day global) or the day of a major surgery

58 Indicates a staged or related procedure or service by the same physician* during the postoperative period

59 Distinct Procedural Service identifies procedures/services not normally reported together, but appropriately billable under the circumstances.

63 Procedure Performed on Infants less than 4 kg

66 If a team of surgeons (more than two surgeons of different specialties) is required to perform a specific procedure, each surgeon bills for the procedure with a modifier “-66.”

74 Discontinued Out-Patient Hospital/Ambulatory Surgery Center (ASC) Procedure after administration of anesthesia

76 Repeat Procedure by the Same Physician; use when it is necessary to report repeat procedures performed on the same day

77 Repeat Procedure by another physician

79 Unrelated procedure by the same physician during the postoperative period

90 Reference (Outside) Laboratory

99 Multiple Modifiers are required on one line of service

*Same physician – Medicare regulation states: “Physicians in the same group practice who are in the same specialty must bill and be paid as though they were a single physician.” The same physician concept also applies when the exact same physician performs services.

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