Modifier CT: New Reporting Guidelines

Modifier CT: New Reporting Guidelines

Effective January 1, 2016, the definition for modifier CT has changed. The new definition may change the way you report claims for computed tomography (CT) scans.

New Definition

Modifier CT Computed tomography services furnished using equipment that does not meet each of the attributes of the National Electrical Manufacturers Association (NEMA) XR-29-2013 standard

“Attributes” of this standard are:

  1. DICOM dose structured reporting
  2. Pediatric and adult reference protocols
  3. CT dose check
  4. Automatic exposure control

When to Report Modifier CT

Report modifier CT with the following CPT® radiology codes when the service is furnished on non-NEMA standard XR-20-2013-compliant equipment:

70450-70498, 71250-71275, 72125-72133, 72191-72194, 73200-73206, 73700-73706, 74150-74178, 74261-74263, 75571-75574 (and any succeeding codes)

What Happens if You Don’t Comply

Providers that fail to attest to this standard beginning this year will be subjected to a 5 percent payment reduction for all CT-designated procedures for Medicare, as it applies to the technical component of the procedure. Beginning in 2017 and subsequent years, the penalty will be 15 percent. System attestation by providers will be verified through the periodic supplier accreditation process (e.g., Joint Commission, ACR, IAC, etc.).

 

Sources:

Medicare Claims Processing Manual, Chapter 4, Section 20.6.12

CPB : Online Medical Billing Course

MITA Smart Initiative

Renee Dustman

Renee Dustman

Executive Editor at AAPC
Renee Dustman, BS, AAPC MACRA Proficient, is an executive editor at AAPC. She holds a Bachelor of Science degree in Media Communications - Journalism. Renee has more than 20 years experience in print production and content management. Follow her on Twitter @dustman_aapc.
Renee Dustman

About Has 607 Posts

Renee Dustman, BS, AAPC MACRA Proficient, is an executive editor at AAPC. She holds a Bachelor of Science degree in Media Communications - Journalism. Renee has more than 20 years experience in print production and content management. Follow her on Twitter @dustman_aapc.

3 Responses to “Modifier CT: New Reporting Guidelines”

  1. Katya C says:

    This is great! Thank you for this information!

  2. cynthia l osborn says:

    Is modifier CT only used on MC claims?

  3. ASaiz says:

    Thank you for your comment. You’ll find a lot of suggestions and better answers to your question in the Member Forums.

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