9 New HCPCS Modifiers to Use
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 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 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)|
- 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 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|