Wiki Modifier question for anesthesia

[beachgrl62]

We are getting denials from Medicare and Medicare RR for the Physical Status modifiers. They are stating that those modifiers are incorrect. Our PFR's want us to change the modifier but there is nothing to change it to. I believe that the modifiers P3-P6 add additonal units to the charges because of the paitent's health status. Did Medicare revise their policy? I have searched the CMS website with no luck. It does state on the Medicare RR site that it is not appropriate to use P-status modifiers on claims. Any help that you can offer will be greatly appreciated! Thank you!

 

[twizzle]

We are getting denials from Medicare and Medicare RR for the Physical Status modifiers. They are stating that those modifiers are incorrect. Our PFR's want us to change the modifier but there is nothing to change it to. I believe that the modifiers P3-P6 add additonal units to the charges because of the paitent's health status. Did Medicare revise their policy? I have searched the CMS website with no luck. It does state on the Medicare RR site that it is not appropriate to use P-status modifiers on claims. Any help that you can offer will be greatly appreciated! Thank you!

Medicare do not recognize the physical status modifiers or the qualifying circumstance modifiers so do not use them otherwise they will definitely be rejected.

 

[beachgrl62]

Thanks for the response. Do you know where on CMS this is documented? I really appreciate your time!

 

[Whitney]

CMS Documentation of Physicial Status Modifiers

Hi. Has anyone found documentation that Medicare does not allow additional reimbursement for these modifiers?

Thank you,

Whitney