Wiki Modifer 24 and 25 for ODJFS

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gepp

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I work in a Family Practice. We do charge entry, but a billing company posts the payments and works the claims. I have been told by this billing company that ODJFS (medicaid) does not recognize modifier 25 and they will only accept modifier 24. I have searched through the ODJFS Manual and can not locate that reasoning. Does anyone know anything about this? Our physicians do not do surgery so I don't understand their reasoning behind this. I need something in writing if anyone can help.
Thank you,
Gail
 
gepp said:
I work in a Family Practice. We do charge entry, but a billing company posts the payments and works the claims. I have been told by this billing company that ODJFS (medicaid) does not recognize modifier 25 and they will only accept modifier 24. I have searched through the ODJFS Manual and can not locate that reasoning. Does anyone know anything about this? Our physicians do not do surgery so I don't understand their reasoning behind this. I need something in writing if anyone can help.
Thank you,
Gail
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Yes, this is correct that MOST MEDICAIDS don't accept modifier 25. You could get this info from your provider relations person. It should be stated in your contract w/them.:)
 
Thank you for your response.
When you say Most Medicaids, would that also apply to Wellcare and Caresourse? I am in Ohio and these are some of the other plans in the Medicaid system.
Does anyone know the reason they do not accept 25? I find it interesting due to the fact that 24 and 25 have different reasoning for their uses.
I will have to get in touch with the provider relations dept.
Thank you
 
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