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...
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