Centers for Medicare & Medicaid Services (CMS), Medicare Claims Processing Manual – Chapter 23 – Fee Schedule Administration and Coding Requirements indicates that “Providers or suppliers shall use anatomic modifiers (e.g., RT, LT, FA, F1-F9, TA, T1- T9, E1-E4) and report procedures with differing modifiers on individual claim lines when appropriate. Many MUEs are based on the assumption that correct modifiers are used”.
Community First will begin denying claims that are not billed with the appropriate anatomical modifiers on 08/05/2024
CMS Resources:
- 9.2.73.4 Bilateral Procedures – Section 9.2.73 Surgery Billing Guidelines Medical and Nursing Specialists, Physicians, and Physician Assistants Handbook (tmhp.com)
- Centers for Medicare and Medicaid Services, Medicare Claims Processing Manual – Chapter 23 – Fee Schedule Administration and Coding Requirements (cms.gov)
Next steps for Providers:
Providers should share this communication with their staff.
Community First Resources:
https://communityfirsthealthplans.com/provider-newsletter
https://communityfirsthealthplans.com/providers/
Contact:
Email ProviderRelations@cfhp.com or call 210-358-6294.