New Modifiers Released in 2018February 13th, 2018 - Chris Woolstenhulme, QCC, CMCS, CPC, CMRS
There were 13 new modifiers released in 2018, be sure you are using them if appropriate. The five new HCPCS modifiers or the "X" modifiers are used for voluntary reporting and do not change the meaning of the procedure being reported. These are used for MACRA patient relationship categories and codes.
|JG||Drug or biological acquired with 340b drug pricing program discount|
|Ordering professional consulted a qualified clinical decision support mechanism for this service and the related data was provided to the furnishing professional|
|TB||Drug or biological acquired with 340b drug pricing program
|X1||Continuous/broad services: for reporting services by clinicians, who provide the principal care for a patient, with no planned endpoint of the relationship; services in this category represent comprehensive care, dealing with the entire scope of patient problems, either directly or in a care coordination role; reporting clinician service examples include, but are not limited to: primary care, and clinicians providing comprehensive care to patients in addition to specialty care|
|X2||Continuous/focused services: for reporting services by clinicians whose expertise is needed for the ongoing management of a chronic disease or a condition that needs to be managed and followed with no planned endpoint to the relationship; reporting clinician service examples include but are not limited to: a rheumatologist taking care of the patient's rheumatoid arthritis longitudinally but not providing general primary care services|
|X3||Episodic/broad services: for reporting services by clinicians who have broad responsibility for the comprehensive needs of the patient that is limited to a defined period and circumstance such as a hospitalization; reporting clinician service examples include but are not limited to the hospitalist's services rendered providing comprehensive and general care to a patient while admitted to the hospital|
|X4||Episodic/focused services: for reporting services by clinicians who provide focused care on particular types of treatment limited to a defined period and circumstance; the patient has a problem, acute or chronic, that will be treated with surgery, radiation, or some other type of generally time-limited intervention; reporting clinician service examples include but are not limited to, the orthopedic surgeon performing a knee replacement and seeing the patient through the postoperative period|
|VM||Medicare diabetes prevention program (
|X5||Diagnostic services requested by another clinician: for reporting services by a clinician who furnishes care to the patient only as requested by another clinician or subsequent and related services requested by another clinician; this modifier is reported for patient relationships that may not be adequately captured by the above alternative categories; reporting clinician service examples include but are not limited to, the radiologist's interpretation of an imaging study requested by another clinician|
|92||Alternative laboratory platform testing: when laboratory testing is being performed using a kit or transportable instrument that wholly or in part consists of a
|95||Synchronous telemedicine service rendered via a real-time interactive audio and video telecommunications system: synchronous telemedicine service is defined as a real-time interaction between a physician or other qualified
|97||Rehabilitative services: when a service or procedure that may be either habilitative or rehabilitative in nature is provided for rehabilitative purposes, the physician or other qualified
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