What is Customary charges

The Customary Charge The customary charge is the amount that best represents the actual charges made for a given medical service or by other persons who supply other medical and health services to the general public. Therefore, obtain information on the customary...

Criteria for Determining Reasonable Charge

There are two criteria in the Act that must be considered in determining the reasonable charge for a service. They are: • The customary charges for similar services generally made by the physician or other person furnishing such services; and • The prevailing charges...

Billing Guide Modifer KX and JW

Modifier KX The KX modifier is a multipurpose, informational modifier and can be used to identify services for transgender, ambiguous genitalia, and hermaphrodite beneficiaries in addition to its other existing uses. Physicians and non-physician practitioners should...

Usage of Modifier GA , GK, GL , GY AND GZ

GA  Waiver of Liability Statement Issued, as Required by Payer Policy ABN required; beneficiary liable To signify a line item is linked to the mandatory use of an ABN when charges both related to and not related to an ABN must be submitted on the same claim Line...