Wiki Podiatry and U7 modifier?

[salaccoder]

Hello everyone,
Has anyone used or heard of using a modifier U7 on podiatry office visits for patient's that have a Medicaid product as their insurance? For example, 99213 with a U7 modifier. I have tried researching this and I am not able to find any supporting documentation for this modifier. Please help!
Thanks!

 

[player14]

I coded Podiatry for the three years and I never used that modifier before (MassHealth - Massachusetts medicaid). That's all I can say, sorry not much help.. How did you come across this - maybe it's a state requirement of yours?

 

[CodingKing]

What state. U modifiers are defined by the Medicaid Agency. I deal with Massachusetts and New York. Of these 2 states only NY uses the U modifiers and MA does not. They may mean something different things based on the code they are attached. I googled texas and its used in Anesthesia and in Mental health

The full description is : Medicaid level of care 7, as defined by each state

 

[salaccoder]

Thank you both for your response! I am billing out of Pennsylvania.

 

[eagomar]

yes, Pennsylvania medicaid requires the U7 modifier. Podiatry has it's own fee schedule under the pa medicaid website.

http://www.dhs.pa.gov/publications/forproviders/schedules/outpatientfeeschedule/index.htm


When you want to know a specific code put 14 in for provider type, 140 for specialty code and then the cpt code. The U7 modifier is used in the office setting only and cannot be billed with any other procedure.
Hope this helps.