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Modifer 24 and 25 for ODJFS

  1. #1
    Question Modifer 24 and 25 for ODJFS
    Medical Coding Books
    I work in a Family Practice. We do charge entry, but a billing company posts the payments and works the claims. I have been told by this billing company that ODJFS (medicaid) does not recognize modifier 25 and they will only accept modifier 24. I have searched through the ODJFS Manual and can not locate that reasoning. Does anyone know anything about this? Our physicians do not do surgery so I don't understand their reasoning behind this. I need something in writing if anyone can help.
    Thank you,
    Gail

  2. #2
    Smile
    Quote Originally Posted by gepp View Post
    I work in a Family Practice. We do charge entry, but a billing company posts the payments and works the claims. I have been told by this billing company that ODJFS (medicaid) does not recognize modifier 25 and they will only accept modifier 24. I have searched through the ODJFS Manual and can not locate that reasoning. Does anyone know anything about this? Our physicians do not do surgery so I don't understand their reasoning behind this. I need something in writing if anyone can help.
    Thank you,
    Gail
    Yes, this is correct that MOST MEDICAIDS don't accept modifier 25. You could get this info from your provider relations person. It should be stated in your contract w/them.
    Yolanda T. Haskins CPC, CRC, OHCC, AAPC Fellow
    Past AAPCCA Board of Directors 2014 - 2017


    Alexandria, VA Chapter

    ~ Practice Kindness ~

  3. #3
    Default
    Thank you for your response.
    When you say Most Medicaids, would that also apply to Wellcare and Caresourse? I am in Ohio and these are some of the other plans in the Medicaid system.
    Does anyone know the reason they do not accept 25? I find it interesting due to the fact that 24 and 25 have different reasoning for their uses.
    I will have to get in touch with the provider relations dept.
    Thank you

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