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Thread: asc medi-cal modifiers

  1. #1
    Join Date
    Apr 2007
    orange, ca

    Exclamation asc medi-cal modifiers

    AAPC: Back to School
    hi! does anyone know the correct medi-cal modifiers for ASC coding? we were using the ZM modifier but now being denied....should i be using AG instead?
    we havent had much medi-cal claims....so not very familiar withthe modifiers required from asc coding...plus, im new to asc coding! any help is appreciated!!

  2. #2

    Default Medi-Cal modifiers

    I haven't coded cases or posted charges that were billed recently from an ASC in California, but I did until last year (7/08). The modifier for an ASC is "ZN", not ZM. Also, we would bill a series of Z-codes that break out the stages of care provided to the patient. Here is an example of how the charges were billed:

    Z7500- exam room
    Z7506- operating room
    Z7512- recovery room
    Z7514- room and board.

    The "ZN" will only be assigned to the primary procedure. Also, I would check, but they may also let you bill them for the supply for T-tube.

    Each of these lines of service will have a fee that is payable and you should be able to reference this info in the provider manual for billing services from an ASC. You should also be able to locate a fee schedule to be able to set the fee for each line of service.

    Good luck

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