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
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Renee Dustman

Managing Editor at AAPC

Renee Dustman, BS, AAPC MACRA Proficient, is managing editor - content & editorial at AAPC. She holds a Bachelor of Science degree in Media Communications - Journalism. Renee has more than 30 years' experience in journalistic reporting, print production, graphic design, and content management. Follow her on Twitter @dustman_aapc.

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