Health Information Management

Are you ready for modifier -CT in 2016?

APCs Insider, November 20, 2015

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By Steven Andrews
As providers work to implement policies and regulations introduced by CMS in the 2016 OPPS final rule, they should take some time before January 1 to make sure they’re ready to potentially report modifier –CT (computed tomography services furnished using equipment that does not meet each of the attributes of the National Electrical Manufacturers Association [NEMA] XR-29-2013 standard).
The modifier was introduced as a result of the Protecting Access to Medicare Act of 2014 and providers will need to append it to certain CPT®/HCPCS codes for CT scans on services furnished on equipment that doesn’t adhere to NEMA standard XR-29-2013. The codes are:
  • 70450–70498
  • 71250–71275
  • 72125–72133
  • 72191–72194
  • 73200–73206
  • 73700–73706
  • 74150–74178
  • 74261–74263
  • 75571–75574
When these codes are reported with the modifier on a claim to be paid separately (i.e., not packaged into a composite APC or comprehensive APC), CMS will impose a 5% payment reduction in 2016 and a 15% payment reduction beginning in 2017. This payment reduction applies under both the Medicare Physician Fee Schedule and the OPPS.
“The first step providers need to take is to talk with staff in the radiology department to determine whether the equipment in their facility is compliant with the NEMA standard,” says Jugna Shah, MPH, president and founder of Nimitt Consulting, based in Washington, D.C., and Spicer, Minnesota. “If the equipment is compliant, that’s great news and those providers will not need to worry about using modifier –CT in 2016 and beyond, nor will they face any payment reductions for their CT services.”
Providers can take steps now if they learn their equipment is not compliant. They should contact their vendors immediately to see if they can get compliant as soon as possible. If that’s not possible, then they will need to immediately determine how to operationalize reporting modifier –CT.
For more information on the modifier, see CMS Transmittal 3402.

To read more about the final rule, see For in-depth coverage of the rule, see the January 2016 edition of Briefings on APCs. For a complete overview and to ask live questions of experts, join Shah and Valerie Rinkle, MPA, for HCPro’s annual OPPS final rule webcast Tuesday, December 8.

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