Modifier 80 - Can I use a modifer 80


Derry, NH
Best answers
Can I use a modifer 80 on a Midwife that assists with a c-section. They have been approved and licensed to assist but isn't 80 for assistant physicians??? or does it not matter?
Midwife Services

See the Medicare Benefit Policy Manual, Chapter 15, for coverage policy for nurse-MIDWIFE services.

130.1 - Payment for Services
(Rev. 1, 10-01-03)
B3-16004.A, B3-16004.B, B3-5257.B, B3-3040.4, B3-17001.1

Billing does not have to flow through a physician or facility.

Payment for most nurse-MIDWIFE services is based on equal to 65 percent of the physician fee schedule. However, covered drugs furnished by nurse midwives are paid according to the drug payment methodology. Covered clinical diagnostic lab services are paid according to the clinical diagnostic lab fee schedule. Note that clinical lab is not subject to deductible and coinsurance

The NMW limitation is applied to the Medicare allowed amount after application of the outpatient mental health limit. As of January 1, 1998, however, restrictions were lifted requiring payments be made to employers and contractors for services provided in SFS or NFS in urban areas and in all settings in rural areas. Payments can now be directly made for outpatient mental health services in all areas and settings as permitted under applicable state licensure laws. Refer to §210 below for a discussion of the outpatient mental health limitation.

Payment is made only on an assigned basis.
NMWs are identified by specialty 42.

130.2 - Global Allowances
(Rev. 1, 10-01-03)
B3-16004.C, B3-5257.C

When a nurse-MIDWIFE is providing care to a Medicare beneficiary and the collaborating physician provides some of the services, the fee paid to the nurse-MIDWIFE is based on the portion of the global fee that would have been paid to the physician for the service provided by the nurse-MIDWIFE.