Wiki AI Modifier Applies to...?

[Journey13]

Does the AI modifier rule only apply to Medicare and Medicaid if my doctor is the admitting physician or all Medicare/Medicaid replacement plans?

Thanks!

Ruthie

 

[danskangel313]

It is my understanding that -AI only applies to Medicare. Other payers, including Medicaid and replacement plans, may or may not recognize the modifier, so you will have to check with those to find out. Since Medicaid is administrated at the state level, anything MC does, doesn't necessarily apply to Medicaid. Here's some info:

This modifier is effective for dates of service on or after January 1, 2010. Submit this modifier with claims from the 'principal physician of record.' HCPCS modifier AI identifies the physician that oversees the patient’s care from all other physicians who may be furnishing specialty care. Only the principal physician of record may submit this modifier.

This modifier may be submitted with the following CPT codes 99221-99223 and 99304-99306. (inpatient admit codes)

 

[mhstrauss]

Does the AI modifier rule only apply to Medicare and Medicaid if my doctor is the admitting physician or all Medicare/Medicaid replacement plans?

Thanks!

Ruthie

We use AI for all payers that no longer accept consults...Medicare, Medicaid, Medicare HMO's, and a couple others. Have not had any problems with any of them.

 

[krystle8402]

We use AI for all payers that no longer accept consults...Medicare, Medicaid, Medicare HMO's, and a couple others. Have not had any problems with any of them.

We have been using them on non-Medicare, non-Medicaid patients as well. Should that be a problem?

 

[mhstrauss]

We have been using them on non-Medicare, non-Medicaid patients as well. Should that be a problem?

Not necessarily. AI was created by Medicare when they stopped accepting consults. What exactly are you using it for? Commercial payers inpatient admit charges?