Services related to mandated consultation and/or related services (eg, third party payer, governmental, legislative or regulatory requirement) may be identified by adding modifier 32 to the basic procedure.
What that means is that, on occasion, an insurance company or other third-party payer sends a patient to a provider for a second opinion, for a specific evaluation or for a determination of disability. When the provider is aware of one of these circumstances, modifier 32 is used to indicate that this is a "mandated service."
The use of modifier 32 is not appropriate when the patient, family members or other parties request second opinions or other services. A common circumstance in which this modifier might be appropriately used is when a patient is sent to a provider by a workers' compensation carrier asking for a second opinion. Another might be when children in state custody are sent to your office for health examinations after being placed in temporary custody or foster care.
Generally speaking, when an encounter is requested by a third party (insurance company, state agency, law enforcement, etc.), consider it a mandated service.
Check with your payer for specifics. For example, WPS Medicare doesn't always feel that the 32 modifier is appropriate.
"Modifier 32 indicates mandated services. This modifier is not appropriate when billing Medicare for federally mandated visits for patients in a Skilled Nursing Facility (SNF) or Nursing Facility (NF). Medicare can make payment for these federally mandated services based on the Centers for Medicare & Medicaid Services (CMS) Internet-Only Manual (IOM) Publication 100-04, Chapter 12, Section 30.6.13.B.
Providers should use Modifier 32 only when reporting a service mandated by an outside entity such as an insurance company, employer, etc. WPS Medicare will deny all services submitted with a modifier 32. If Modifier 32 is appropriate for the situation, you should not need to request a redetermination."