Sunday, April 3, 2011

Modifier AZ and PT - Colorectal Cancer screening test modifier

AZ & PT - New Modifier for 2011

Modifier AZ: Physician service in dental HPSA

Long description: “Physician providing a service in a Dental Health Professional Shortage Area for the purpose of an Electronic Health Record Incentive payment.”

In order to allow EPs to report claims rendered in a dental HPSA when the zip code does not fully fall within the dental HPSA, CMS has developed a new EHR HPSA modifier AZ. It is effective for dates of service on and after January 1, 2011. The new modifier will not affect the payment or calculation of the FFS geographic quarterly HPSA bonus.

The Integrated Data Repository will be responsible for determining which EPs are due the EHR HPSA incentive payment increase and determining the amount of the payment.

- Colorectal Cancer screening test, converted to diagnostic test or other procedure

Modifier PT should be appended for the diagnostic procedure code that is reported instead of the screening colonoscopy or screening flexible sigmoidoscopy HCPCS code, or as a result of the barium enema when the screening test becomes a diagnostic service. This will prompt the claims processing system to waive the deductible for all surgical services on the same date of service as the diagnostic service. Modifier PT should be appended only if the planned screening service becomes a diagnostic service.

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