Advantage and OHP Modifier List 01/01/2010 retired 12/31/2012

Transcription

1 DME MODIFIER LIST Effective for dates of service beginning 1/1/13, the CareOregon modifier list should NOT be used. Rationale some of the HCPCS codes in the list are no longer valid. Since codes and modifiers undergo changes quarterly, CareOregon has decided that the most accurate list that we and our providers should use is the following: For Medicare members (CareOregon Advantage) follow the CMS guidelines for modifiers. For Oregon Health Plan members follow the DMAP guidelines for modifiers.

2 Advantage and OHP Modifier List 01/01/2010 retired 12/31/2012 NOTE: For the HCPCS listed below, the correct modifier is required for authorization and claims submittal when applicable. For HCPCS codes not listed, if a modifier is associated with the code, the modifier must be included in the authorization request and submitted with the claim for correct claim processing. This is not a full list of all HCPCS codes, only the most frequently used ones. * is required for CareOregon Advantage (Medicare) only. If an HCPCS code allows NU, RA, RB or RR, use modifier that applies to situation. If NU is only listed for the HCPCS code, enter NU. MS = maintenance and service fee for reasonable and necessary parts and labor which are not covered under any manufacturer or supplier warranty NU = new equipment (CareOregon Advantage only) QE = oxygen is <1 LPM (CareOregon Advantage only) QF = oxgyen is >4 LPM + portable O2 (CareOregon Advantage only) QG = oxygen is >4 LMP (CareOregon Advantage only) RA = replacement of a DME item RB = replacement of a part of DME furnished as part of a repair RR = rental of DME equipment HCPCS Excluded from Coverage Modifier Modifier Modifier Modifier A4253 A5513 Standard A7003 Standard A7004 Standard A7005 Standard A7010 Standard A7012 Standard A7013 Standard A7015 Standard A7030 A7031 A7032 A7033 A7034 A7035 A7036

3 A7037 A7038 A7039 A7046 E0143 Standard NU RA or RB RR E0163 Standard NU E0202 Standard RR E0240 COA/Standard NU RA or RB E0241 COA/Standard NU RA or RB E0243 COA/Standard NU RA or RB E0244 COA/Standard NU RA or RB E0245 COA/Standard NU RA or RB E0246 COA/Standard NU RA or RB E0247 COA/Standard MS RA or RB RR E0248 COA/Standard MS NU RA or RB RR E0255 Standard MS NU RA or RB RR E0260 Standard MS NU RA or RB RR E0277 Standard MS NU RA or RB RR E0303 Standard MS NU RA or RB RR E0424 QE QF QG E0431 MS NU RA or RB RR E0434 MS NU RA or RB RR E0439 MS NU RA or RB RR E0439 QE QF QG E0445 NU RA or RB RR E0470 MS NU RA or RB RR E0471 MS NU RA or RB RR E0562 RA or RB RR E0570 Standard MS NU RA or RB RR E0600 MS NU RA or RB RR E0601 MS NU RA or RB RR E0607 NU RA or RB RR E0630 Standard MS NU RA or RB RR E0910 Standard MS NU RA or RB RR E0950 Standard NU RA or RB RR E0955 Standard NU RA or RB RR E0956 Standard NU RA or RB RR E0957 Standard NU RA or RB RR E0960 Standard NU RA or RB RR E0961 Standard NU RA or RB RR E0971 Standard NU RA or RB RR E0973 Standard NU RA or RB RR E0978 Standard NU RA or RB RR E0981 Standard NU E0990 Standard NU RA or RB RR E1002 Standard NU RA or RB RR E1028 Standard NU RA or RB RR E1161 Standard NU RA or RB RR E1226 Standard NU RA or RB RR E1233 Standard NU RA or RB RR E1340 Standard NU RA or RB E1372 Standard NU RA or RB RR

4 E1390 NU RA or RB RR E1390 QE QF QG E1391 QE QF QG E1805 Standard MS NU RA or RB RR E2201 Standard NU RA or RB RR E2206 Standard NU RA or RB RR E2208 Standard NU RA or RB RR E2210 Standard NU RA or RB RR E2213 Standard NU RA or RB RR E2311 Standard NU RA or RB RR E2361 Standard NU RR E2363 Standard NU RR E2365 Standard NU RR E2366 Standard NU RR E2370 Standard NU RA or RB RR E2377 Standard E2381 Standard E2382 Standard E2384 Standard E2386 Standard E2387 Standard E2392 Standard E2402 Standard MS RR E2601 Standard NU RA or RB RR E2603 Standard NU RA or RB RR E2607 Standard NU RA or RB RR E2609 Standard NU RA or RB RR E2611 Standard NU RR E2615 Standard NU RR E2617 Standard NU RR E2619 Standard NU RR E2620 Standard NU RR K0001 Standard MS NU RA or RB RR K0002 Standard MS NU RA or RB RR K0003 Standard MS NU RA or RB RR K0004 Standard MS NU RA or RB RR K0005 Standard NU RA or RB RR K0006 Standard MS NU RA or RB RR K0007 Standard MS NU RA or RB RR K0019 Standard NU RA or RB RR K0040 Standard NU RA or RB RR K0043 Standard NU RA or RB RR K0044 Standard NU RA or RB RR K0052 Standard NU RA or RB RR K0077 Standard NU RA or RB RR K0195 Standard MS NU RA or RB RR K0462 Standard K0734 Standard L1800 Standard NU L1830 Standard NU L1902 Standard NU L1907 Standard NU

5 L1960 Standard NU L1970 Standard NU L2200 Standard NU L2210 Standard NU L2275 Standard NU L2820 Standard NU L2830 Standard NU L3020 Standard NU L3807 Standard NU L3908 Standard NU L4205 Standard NU RA or RB L4360 Standard NU RA or RB L4386 Standard NU RA or RB L4392 Standard NU RA or RB L4396 Standard NU RA or RB L5620 Standard NU L5629 Standard NU L5637 Standard NU L5668 Standard NU L5671 Standard NU L5673 Standard NU L5685 Standard NU RA or RB L5910 Standard NU L5940 Standard NU L5986 Standard NU L8000 Standard NU L8400 Standard NU L8420 Standard NU L8440 Standard NU L8470 Standard NU The use of an identified code and modifier above is no guarantee of payment. Payment for a given supply or service is based on eligibility, authorizations, and clinical criteria that may apply to a code and/or code set.