Medicare to begin accepting appropriate use claims modifier in January

Jul 29, 2019 - 03:22 PM
CMS_update

Medicare Administrative Contractors should begin accepting modifier codes for appropriate use criteria on Medicare claims for advanced diagnostic imaging on Jan. 1, the start of the one-year educational and operations testing period, the Centers for Medicare & Medicaid Services announced Friday. The Protecting Access to Medicare Act of 2014 established a program to increase the rate of appropriate advanced diagnostic imaging services furnished to Medicare beneficiaries. When fully implemented in 2021, the program will require clinicians ordering an advanced imaging service for a Medicare beneficiary to consult an interactive electronic tool to determine whether the order adheres to the criteria and append information related to the consultation to claims. During the 2020 test year, Medicare will continue to pay claims that do not include the consultation information. AHA is working with other stakeholders to develop a mechanism for furnishing facilities to report the appropriate use criteria consultation information.

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