Modifier U2


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Can someone explain the purpose of the modifier U2 on cpt 59514. When I look it up it only says Medicaid level 2, I want to understand so I will know to code with them or not.


True Blue
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Each states medicaid program can define how the modifier is to be used so you will have to check directly. I believe they are designed to allow Medicaid to stay HIPAA compliant since they cant make up their own codes. I maintain some fee schedules for a project my company has with NY medicaid and out there, its used for many things like w/ Personal Care Attendant, Adult Foster Care, Adult day care to specify different levels. There is only one code to report the service so they use the U modifiers to specify levels, weekends, alternative placement etc. and that allows setting different rates for each level since its impossible to set multiple rates for the same HCPCS code

Another example is UHC Community Plan TX, for the delivery codes, U2 is Delivery at 39 weeks gestation or later. U1 is Medically necessary delivery prior to 39 weeks of gestation. U3 is a not covered non-medically necessary delivery prior to 39 weeks gestation.
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