by Lori | May 22, 2011 | CPT modifiers
REIMBURSEMENT GUIDELINES Oxford will reimburse a CPT or HCPCS code only once during the Defined Treatment or Monitoring Period. Multiple submissions of the same CPT or HCPCS code by the Same Physician, Hospital, Ambulatory Surgical Center or Other Health Care...
by Lori | May 18, 2011 | CPT modifiers
Renewed Moratorium on Outpatient Therapy Codes Section 4541(a)(2) of the Balanced Budget Act (BBA) (P.L. 105-33) of 1997, which added §1834(k)(5) to the Social Security Act (the Act), required payment under a prospective payment system for outpatient rehabilitation...
by Lori | May 16, 2011 | CPT modifiers
Modifier SG Fact Sheet Definition: • Services Performed at an Ambulatory Surgical Center* (ASC) facility Appropriate Use: • Do not use for dates of service January 1, 2008 and after. • Use on claims for the ASC facility services. • Claims must be submitted as assigned...
by Lori | May 13, 2011 | CPT modifiers
Q & A about modifiers Should modifier -52 (reduced services) be used for a procedure that is defined as bilateral by the CPT/HCPCS code when the provider was able to perform only one side of the procedure or service? Yes. It is appropriate to use modifier...
by Lori | May 11, 2011 | CPT modifiers
Modifier GY Fact Sheet Definition: • 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. Example: Patient transport is for a non-covered condition that does not meet the...
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