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AI modifier - Medicare only?

  1. #1
    Albany, Oregon
    Default AI modifier - Medicare only?
    Clearnace Sale
    Hello fellow coders,

    Yet another question regarding the AI modifier - Should it be used on non-Medicare claims?

    Our organization is instructing us to use AI on the initial e/m code for the physician of record on all claims, but I've been querying other coders and I've gotten quite a few answers of "Medicare only". Another coder informed me that non-Medicare payers do not accept HCPCS modifiers (eg, AS). Huh?

    I'd love to know what other organizations are doing. Does anyone have a definitive (quotable to corporate!) answer?

    Thanks in advance,
    Pat Kidd, CPC

  2. #2
    New Windsor, New York
    Default Check with the payer.
    I know that this sounds like a cop-out, but it is best to check with the payer to see if they (A) will accept the consultation codes and if not, (B) recognize that modifier.

  3. #3
    I agree. The AI modifier was developed specifically for Medicare use to identify the physician of record during an admit. You shouldn't need this modifier to the commercail payers since they still accept the consult codes.
    Walker Bachman, CPC, CPPM

  4. #4
    Albany, Oregon
    Default AI modifier / Medicare
    Thanks to all who responded via this site and to my e-mail address.
    I appreciate your comments.

  5. Default Modifier 57
    MLN article MM6740 were cms announces the change regarding consultation codes indicates the following:
    "This article only applies to physicians billing the Medicare fee-for-service program. It does not apply to Medicare Advantage or non-Medicare insurers."
    So the AI is a Medicare only rule. I know that there are insurance companies that will follow the consultation rule for their MA product but not for their non Medicare products. So the best bet is to check with the other insurance companies directly.

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