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UD Modifier

  1. #1
    Question UD Modifier
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    Hello,

    Does anyone used UD modifier before? And if so can you explain what the modifier means? I have never seen this modifier before and unable to find the reason online. Any help will be appreciated.

  2. #2
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    something to do with medicaid and drug discounts. you may need to check with your states Medicaid.

    https://www.340bhealth.org/files/PP_..._Discounts.pdf

    https://www.cms.gov/Medicare/Medicar...pital-OPPS.pdf

    18. How are providers to bill the 340B modifiers for drugs administered to dual-eligible beneficiaries? Is the “UD” modifier required for Medicaid?

    When Medicare is either the primary or secondary payer, the appropriate 340B modifier is required in accordance with the OPPS 340B payment policy. Because Medicaid billing requirements vary by state, providers should contact the applicable State Medicaid Program for guidance on billing 340B drugs. Normal CMS policy and procedures and trading partner agreement requirements for coordination of benefits (COB) claims will be followed.
    Last edited by CodingKing; 10-23-2018 at 09:48 AM.
    CRC (2018), CPC-P-A (2016), COC-A (2016), CPC-A (2015), PAHM (2010)
    Contract/Fee Specialist - Remote

    20 years health insurance experience: Audit, Claims, Customer Service, Payment Policy, Provider Relations, and Reimbursement

  3. #3
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    Okay so for example I have a claim that performed an Abodomen CT with IV and oral contrast at the same time. For this claim the IV and oral contrast were performed at the same time together so I am unable to append a modifier XU since performed together. So I was looking into appending mod UD on it, but it is still not making sense. I have been researching all week for a good definition but it still isn't making sense. Is there anyway you can explain it more? Or you can email me at hbarney2017@gmail.com

  4. #4
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    I'm not super familiar with the modifier but i believe its only attached to the Drug code (J code/Q code) if the drug was purchased through the 340B discount program

    https://en.wikipedia.org/wiki/340B_Drug_Pricing_Program
    CRC (2018), CPC-P-A (2016), COC-A (2016), CPC-A (2015), PAHM (2010)
    Contract/Fee Specialist - Remote

    20 years health insurance experience: Audit, Claims, Customer Service, Payment Policy, Provider Relations, and Reimbursement

  5. #5
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    Are you wanting to bill both the IV solution and the oral contrast? and is this denying from the payer? Is this the facility or the physician claim.

    Debra A. Mitchell, MSPH, CPC-H

  6. #6
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    Quote Originally Posted by mitchellde View Post
    Are you wanting to bill both the IV solution and the oral contrast? and is this denying from the payer? Is this the facility or the physician claim.
    Yes it denied Q9967 (needing the modifier) with Q9963. Yes they want to bill both the IV and oral contrast but it was performed same time. Yes it is denying from the payer and this is an outpatient claim.

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