Wiki Where would I find what modifiers are required or not required based on payer? For example Medicaid does not accept anatomical modifiers?

[Hope061280]

Where would I find what modifiers are required or not required based on payer? For example Medicaid does not accept anatomical modifiers I have been told and Humana does require them.. Where would I find that information for myself as the coder? Medicaid fee schedule does not indicate that info from what I have found... Thanks

 

[trarut]

The commercial payers usually have reimbursement policies or claim edit documents that indicate what modifiers they require or will accept as informational. Ohio Medicaid includes modifiers in a sub-section of their physician fee schedule. If the modifier isn't listed, they won't accept it. The Medicare Physician Fee Schedule on the CMS website provides modifier guidance in columns on the report and use codes in the line detail to indicate if the modifier is required. You'll likely need the instructional document they provide to interpret it if you haven't had the pleasure of working with it before.

 

[Hope061280]

The commercial payers usually have reimbursement policies or claim edit documents that indicate what modifiers they require or will accept as informational. Ohio Medicaid includes modifiers in a sub-section of their physician fee schedule. If the modifier isn't listed, they won't accept it. The Medicare Physician Fee Schedule on the CMS website provides modifier guidance in columns on the report and use codes in the line detail to indicate if the modifier is required. You'll likely need the instructional document they provide to interpret it if you haven't had the pleasure of working with it before.

Thank you!

 

[prayercoder]

Alabama Medicaid accepts anatomical modifiers; for some codes they are required. You may go to the individual state's Medicaid website for help. If not found there, Medicaid has Customer Support to assist with questions.