Wiki Modifier 50 on a CPT code with a status indicator J1

[lanae811]

Can I expect to get reimbursed at 150% for the 50 modifier when it is billed on a CPT code with a J1 status indicator? Trying to find documentation to support this and I am having trouble. Any suggestions on supporting documentation would also be appreciated!
Thanks for your help!

 

[haraml7]

J1 status indicator states: "Hospital Part B Services Paid Through a comprehensive APC". I am interpreting that as it is just stating a part B provider is paid through the OPPS.

Here is a link I found that may help in your decision. I do not know the codes that you are trying to bill under the J1 status indicator is just a "way of payment per OPPS" and the 50 modifier is letting the insurance company know that the provider (part B) did a bilateral procedure.

Also, is your code payable per CMS as 150%? This can be found on the CMS website as well under the fee schedule. put in your code and look at bilateral area at the bottom and if there is a 0,1,9 indicator will tell you if the reimbursement will be 100% or 150%.

fcso.medicare.com

https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/Downloads/HospitalOutpaysysfctsht.pdf

Thanks, I hope the link helps
Please email me if you have any other questions
Misty