CHA News Article

CMS Issues Claims Modifier for Consultation of Appropriate Use Criteria for Imaging

The Centers for Medicare & Medicaid Services has issued an MLN Matters article informing Medicare administrative contractors about a new claims modifier that providers should use when a qualified clinical decision support mechanism (CDSM) is consulted to determine appropriate use criteria for advanced diagnostic imaging services. As finalized in the calendar year 2018 physician fee schedule, beginning on July 1 hospitals may voluntarily report if a CDSM is consulted for appropriate use criteria for advanced diagnostic imaging services that are paid under the physician fee schedule, outpatient prospective payment system or ambulatory surgical center prospective payment system. Beginning Jan. 1, 2020, reporting will be mandatory.

The modifier “QQ” may be reported on the same claim line as the CPT code for the advanced diagnostic imaging service furnished. The modifier may be reported on both the facility and professional claim. Additional information, including which facility settings and payment systems are included in the program, is available in the article.

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