Wiki PT Modifier - CMS

[sbarrila]

Does anyone have any information on the use of the PT modifier for screening procedures (GI) as of 1/1/11. I am unable to locate anything on CMS and a lot of our commercial payers & Medicare managed care plans know nothing about this modifier. Any help is appreciated. Thanks,

 

[cbarry]

The PT modifier information is located in the MLN Matters number MM7012 release date 07/30/10. Not sure if that helps or not. The good thing is that if the patient comes in for a screening colon and then becomes diagnostic, append the PT modifier and the deductible and the co-ins are still waived as if it were a screening.

 

[sbarrila]

from what i understand it is only the deductible that is waived, not the coinsurance

 

[mitchellde]

That is correct it is the deductible that is waived.

 

[andavis234]

The PT modifier information is located in the MLN Matters number MM7012 release date 07/30/10. Not sure if that helps or not. The good thing is that if the patient comes in for a screening colon and then becomes diagnostic, append the PT modifier and the deductible and the co-ins are still waived as if it were a screening.

we have a denial for 45385 and the insurance company (NOT Medicare) is requesting PT modifier to be added- is there a different modifier other than PT for this circumstance? thank you in advance.