Question CCS MediCal Modifiers -HA & -TG

y4zhill

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Hi all -

I am trying to find guidance for the billing and reimbursement of critical care codes, for CCS MediCal.
June 1st, the reporting codes changed from Z0100-Z0108 to the use of CPT E/M codes.
Modifiers -HA and -TG are to be used on codes 99291 & 99292.
By nature of the CCS parameters, these cases are for children and it happens that most of our cases are complex.
This necessitates our use of both modifiers.
  • -HA = child or adolescent program
  • -TG = complex/high tech level of care
Our payment for these codes and modifiers are varied.
The interesting part is when billed with -HA and/or -TG, we are receiving less payment as opposed to a higher payment (which is expected).
  1. using modifiers -HA and -TG, we are seeing $296.01
  2. with just modifier -TG, we are seeing $120.38
  3. with no modifier, we are seeing $413.52
Does anyone have any insight on these modifiers?
Does anyone have any insight on CCS reimbursement for CC codes 99291 & 99292?

Thanks in advance ~
 
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