Wiki Medi-Cal AG modifier use

[coachlang3]

Has anyone had compliance issues with Medi-Cal's use of the AG modifier for a primary procedure?

They say they use if differently from the national definition. They use it to denote a primary procedure instead of the correct usage as the primary physician in a shortage area.

According to their website modifier page they want AG on the primary procedure and 51 on all others.

I can't find the actual update from Medi-cal when this went into effect in 2005.

Thanks!!!!!

 

[Samantha.Prince]

Medi-Cal

The code sets and modifier descriptions are a nationally set. I would request documentation from the insurer about why this change was made and I would appeal any denials you have received.

I work for a state Medicaid agency (not Medi-Cal) and we follow the national code sets. Medi-Cal can designate one of their state defined modifiers for that use but the primary procedure should not have any modifiers per correct coding rules.