Know Before You Bill-Medicare Modifiers
How disappointing it is when a clinic completes the intake process, exam, treatment and detailed documentation on a patient only to receive a claim denial for ‘missing modifier or incorrect modifier’. Are misapplied modifiers killing your Medicare reimbursement? Take a moment to check out these helpful tips!
Below is a list of modifiers, their descriptions and/or instructions, and what, if any affect the modifier has on the Medicare payment. The list is divided into two categories: modifiers used only on chiropractic manipulative treatment (CMT) codes and modifiers used on all other services.
Modifiers Used with Spinal CMT Codes (98940, 98941, and 98942 only)
Code | Description/Instruction | Effect on Medicare Payment |
AT |
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Medicare will consider the service for payment since it has been deemed “active treatment” They will apply appropriate screens and consider whether the service is medically necessary. |
GA
Waiver of liability statement on file |
GA stands for “Got ABN!”
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If the patient chooses Option 1 on the ABN form, you must bill the service. The GA modifier is appended to the appropriate CMT code. |
GZ |
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Effective July 1, 2011, all claim line items submitted with GZ modifiers will be denied automatically They will not be subject to complex medical review. |
Modifiers Used with Non-Spinal CMT Codes (Every other service ordered or delivered by a DC)
Code | Description/Instruction | Effect on Medicare Payment |
GY |
|
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GP |
|
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GX
Notice of Liability Issued, Voluntary Under Payer Policy. |
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Heads Up!
CPT Code 97010: Medicare considers this code (hot/cold packs) a ‘bundled’ service. When a service is bundled, it means that the reimbursement for the code is built into or grouped with the reimbursement for another code. In this instance, it means services described by 97010 are not separately billable when rendered to a Medicare patient.
CPT Code 97014: When you submit electrical muscle stimulation to Medicare for the purposes of denial and to be eligible for submission to a secondary plan, you must use G0283 to receive the proper denial from Medicare. You then will use the modifier GY and possibly GP (if your Medicare carrier requires this) to receive a denial that will allow you to submit to a secondary carrier. This code may or may not be accepted by other carriers and you may have to modify your practice systems to use G0283 only for submission of electrical muscle stimulation treatment to Medicare and the CPT code 97014 to other carriers.
Now that you are on your way to appending proper modifiers, there is one more billing topic we need to address. It is related to patient billing for those who are Medicare QMBs.
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