Sunday, December 20, 2015

HPSA And PSA Modifiers -AQ, AR, PQRS Modifiers - 1P, 2P,3P,8P, Ambulance Modifiers - QM,QN,QL

Health Professional Shortage Area (HPSA) and Physician Scarcity Area (PSA) Modifiers

Modifier    Description
AQ    Service performed in a Health Professional Shortage Area. This modifier is used by physicians to indicate the services reported were rendered in a qualified Health Professional Shortage Area (HPSA) and are eligible for the 10% incentive payment.
AR    Physician providing services in a physician scarcity area.

Provider Quality Reporting Initiative (PQRI) Modifiers

These modifiers are only to be used for PQRI, no other modifiers should be used when reporting PQRI.

Modifier    Description
1P    Performance Measure Exclusion Modifier Due to Medical Reasons
2P    Performance Measure Exclusion Modifier Due to Patient Choic    
3P    Performance Measure Exclusion Modifier Due to System Reasons
8P    Performance Measure Reporting Modifier - Action Not Performed, Reason Not Otherwise Specified

Ambulance Modifiers
For ambulance service claims, institutional-based providers and suppliers must report an origin and destination modifier for each ambulance trip provided in HCPCS/Rates.
Origin and destination modifiers used for ambulance services are created by combining two alpha characters. The first position alpha code equals origin; the second position alpha code equals destination.  

Origin/Destination    Description
D    Diagnostic or therapeutic site other than P or H when these are used as origin codes
E    Residential, domiciliary, custodial facility (other than 1819 facility)
G    Hospital based ESRD facility
H    Hospital
I    Site of transfer (e.g. airport or helicopter pad) between modes of ambulance transport
J    Freestanding ESRD facility
N    Skilled nursing facility
P    Physician’s office
R    Residence
S    Scene of accident or acute event
X    Intermediate stop at physician’s office on way to hospital
Note: This is a destination code only

In addition, institutional-based providers must report one of the following modifiers with every HCPCS code to describe whether the service was provided under arrangement or directly. 

Modifier    Description
QM    Ambulance service provided under arrangement by a provider of services
QN    Ambulance service furnished directly by a provider of services
QL    Patient pronounced dead after ambulance called

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