9 New HCPCS Modifiers to Use
- By Brad Ericson
- In CMS
- December 10, 2018
- 4 Comments
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 provide 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
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
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.
| 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) |
Modifier QQ
- 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 |
Modifier VM
Part of the Medicare Diabetes Prevention Program (MDPP) expanded model, this modifier can be added to G9874-G9879 and G9882-G9891 to identify a virtual make up session.
| VM | Medicare diabetes prevention program (MDPP) virtual make-up session |
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Hello,
My name is Barb and I am a biller for a pediatrician. My doctor wanted to know if we can bill the insurance companies for an ace strap, heel cups, finger splints and other durables. My understanding is that you have to have a DME license. Please correct me if I am wrong or please educated me regarding this situation. Thank you very much for your time.
The new ER modifier conflicts with the HCPCS transportation modifier ER combination. Anyone having issues with claims reported using the ER modifier?
I am with a Physical Therapy Office and we are just now running into medicare patients that are requiring the KX modifier for reaching their therapy cap. Do you have any information or advice in regards to the order of the KX modifier with the CQ modifier for services furnished by a PTA? Thank you.