by Medical Billing | Oct 16, 2014 | CPT modifiers
QW – CLIA WAIVED TEST The Clinical Laboratory Improvement Amendments of 1988 (CLIA) regulations require a facility to be appropriately certified for each test performed. To ensure that Medicare & Medicaid only pay for laboratory tests categorized as...
by Medical Billing | Sep 25, 2014 | CPT modifiers
The Medicare National Correct Coding Initiative (NCCI) has Procedure to Procedure (PTP) edits to prevent unbundling of services, and the consequent overpayment to physicians and outpatient facilities. The underlying principle is that the second code defines a subset...
by Medical Billing | Sep 18, 2014 | CPT modifiers
Modifier -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,...
by Medical Billing | Aug 22, 2014 | CPT modifiers
Modifier -GL Medically Unnecessary Upgrade Provided instead of Non-Upgraded Item, No Charge, No ABN Can’t be used if ABN/HHABN is required, COPs may require notice, recommend documenting records; beneficiary liable Use only with durable medical equipment (DME) items...
by Medical Billing | Jul 14, 2014 | CPT modifiers
Modifier – EY No Physician or Other Licensed Health Care Provider Order for this Item or Service None, cannot be used when HHABN or ABN is required, recommend documenting records; liability is provider unless other modifiers are used (-GL, -GY, or –TS) To...
by Medical Billing | Apr 22, 2014 | CPT modifiers
With the upcoming MMIS upgrade, WV Medicaid will be editing claims based on NCCI methodologies. An FAQ is posted below with some commonly asked questions. The CMS website was used to formulate responses and can also be a useful source of reference for more information...
by Medical Billing | Mar 27, 2014 | CPT modifiers
NDC Billing Instructions Molina EDI Help Desk is reporting claims are being rejected because more than one NDC code is being billed on one service line. Below you will find instructions on billing multiple NDC codes for the same drug on a claim. For...
by Medical Billing | Mar 13, 2014 | CPT modifiers
Category II Code Description 0509F Urinary incontinence plan of care documented 0518F Falls plan of care documented 0521F Plan of care to address pain documented 1031F Smoking status and exposure to second hand smoke in the home assessed 1032F...
by Medical Billing | Dec 2, 2013 | CPT modifiers
ABN modifiers When a patient is notified in advance that a service or item may be denied as not medically necessary , the provider must annotate this information on the claim (for both paper and electronic claims) by reporting modifier GA (waiver of liability...
by Medical Billing | Oct 30, 2013 | CPT modifiers
These FAQs attempt to address some commonly asked questions about the interaction and timing between the Shared Savings Program and the traditional PQRS. Q1: Are eligible professionals that bill through ACO participant TINs eligible to participate in the PQRS...
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