Thursday, August 4, 2016

CPT modifiers KB, QL, TQ AND GX

KB Beneficiary Requested Upgrade for ABN, more than 4 Modifiers on a Claim

ABN Required; if service denied in development, beneficiary assumed liable
Use only on line items requiring more than [2 or ] 4* modifiers on home health DME claims (TOBs 32x, 33x, 34x)
Line item submitted as covered, claim must suspend for development

QL Patient pronounced dead after ambulance called

None, recommend documenting records; provider liable
Use only for ambulance services (TOBs: 12x, 13x, 22x, 23x, 83x, 85x)
Mileage lines submitted as non-covered and will be denied; base rate line submitted covered

TQ Basic life support transport by a volunteer ambulance provider

Not payable by Medicare
None, recommend documenting records; provider liable
Use only for ambulance services (TOBs: 12x, 13x, 22x, 23x, 83x, 85x)
Lines submitted as non-covered and will be denied

GX Notice of Liability Issued, Voluntary Under Payer Policy

Used when a provider issued an ABN on a voluntary basis; beneficiary liable
Use on all types of provider claims when a voluntary notice has been issued. May be used in association with modifiers –GY or used separately.
Lines submitted as non-covered and will be denied

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