Wiki modifier for urgent procedure out of network

[sclarry@dermsos.com]

I have a patient who has Medicare of Nevada and we are in Washington State. We are not enrolled in Nevada however her provider has referred her to have a melanoma removed while she is here for the summer. Is there a modifier that can be attached to the claim showing it is an emergent claim out of network?

 

[thomas7331]

There is no modifier for this that I'm aware of. If it's regular Medicare, then it won't make a difference as they will cover the services in any state. But if the patient is enrolled in a Nevada Medicare Advantage plan, you want to contact the plan and see if you can get an authorization for this. It may be a hard sell though, because if you're planning a procedure in advance, it could be hard to persuade the plan that this really meets their definition of emergent.