A modifier is a two-digit numeric or alphanumeric character reported with an HCPCS code, when appropriate. Modifiers are designed to give Medicare and commercial payers additional information needed to process a claim. This includes HCPCS Level I (Physicians’ Current Procedural Terminology [CPT®]) and HCPCS Level II codes. A modifier provides the means by which a physician or facility can indicate or “flag” a service provided to the patient that has been altered by some special circumstance(s), but for which the basic code description itself has not changed.
The 2019 HCPCS Level II code set includes an unusual nine new modifiers that help medical coders and billers accurately report services recently adopted or changed by Medicare. Some are already effective; others are effective January 1, 2019.
Modifiers CO and CQ
Modifiers CO and CQ identify therapy services provided by an occupational therapy assistant (OTA) or physical therapy assistant (PTA).
As described by AAPC Executive Editor Renee Dustman in “Therapy Services Get a Workout in Medicare Final Rule,” these new modifiers are payment modifiers to be used when an OTA or PTA provides more than 10 percent of the service. The Centers for Medicare & Medicaid Services (CMS) plans to more completely revamp therapy services in the 2020 Medicare Physician Fee Schedule (MPFS).
|CO||Outpatient occupational therapy services furnished in whole or in part by an occupational therapy assistant|
|CQ||Outpatient physical therapy services furnished in whole or in part by a physical therapist assistant|
Modifier ER is primarily a billing modifier to help identify items and services furnished by an off-campus, provider-based emergency department.
|ER||Items and services furnished by a provider-based, off-campus emergency department|
Modifier G0 (G zero) is effective beginning January 1, 2019, to identify telehealth services furnished for purposed of diagnosis, evaluation, or treatment of symptoms of an acute stroke.
It’s valid for all of the following:
- Telehealth distant site codes billed with Place of Service (POS) code 02
- Telehealth originating site facility fee billed with code Q3014
- Critical Access hospitals (revenue codes 096X, 097X, or 098X)
|G0||Telehealth services for diagnosis, evaluation, or treatment, of symptoms of an acute stroke|
Modifiers QA, QB, and QR
These oxygen services modifiers were effective April 1 and join existing modifiers QE, QF, and QG. If the prescribed amount of oxygen is less than 1 LPM, suppliers use modifier QA with the stationary oxygen HCPCS Level II code, the monthly payment amount for stationary oxygen is reduced by 50 percent. This modifier is used when the prescribed flow rate is different for nighttime use and daytime use and the average of the two flow rates is used in determining the volume adjustment.
If the prescribed amount of oxygen is greater than 4 LPM and portable oxygen is prescribed, suppliers use modifier QB, with both the stationary and portable oxygen HCPCS Level II code, HHAs use revenue code 0604. If the prescribed flow rate differs between stationary and portable oxygen equipment, the flow rate for the stationary equipment is used. The monthly payment for stationary oxygen is increased by the highest of 50 percent of the monthly stationary payment amount or the fee schedule amount for the portable oxygen add-on. A separate monthly payment is not allowed for the portable equipment if the stationary oxygen fee schedule amount is increased by 50 percent.
If the prescribed amount of oxygen is greater than 4 LPM, suppliers use Modifier QR, HHAs use revenue code 0603. The monthly payment amount for stationary oxygen is increased by 50 percent.
|QA||Prescribed amounts of stationary oxygen for daytime use while at rest and nighttime use differ and the average of the two amounts is less than 1 liter per minute (lpm)|
|QB||Prescribed amounts of stationary oxygen for daytime use while at rest and nighttime use differ and the average of the two amounts exceeds 4 liters per minute (lpm) and portable oxygen is prescribed|
|QR||Prescribed amounts of stationary oxygen for daytime use while at rest and nighttime use differ and the average of the two amounts is greater than 4 liters per minute (lpm)|
- Beginning last July, modifier QQ can be appended for the following situations:
- When the furnishing professional is aware of the result of the ordering professional’s consultation with a CDSM for that patient
- On the same claim line as the CPT code for an advanced diagnostic imaging service furnished in an applicable setting and paid for under an applicable payment system
- On both the facility and professional claim
Check with your payer or consult MM10481 for the codes for which fall within certain ranges.
|Ordering professional consulted a qualified clinical decision support mechanism for this service and the related data was provided to the furnishing professional|
Part of the Medicare Diabetes Prevention Program (MDPP) expanded the model, this modifier can be added to G9874-G9879 and G9882-G9891 to identify a virtual makeup session.
|VM||Medicare diabetes prevention program (MDPP) virtual make-up session|