The Centers for Medicare & Medicaid Services (CMS) has changed a service code related to screening mammography, meaning you might need to reprocess claims from earlier this year.
In addition, a new modifier for advanced diagnostic imaging services is soon to become active, but it will be voluntary.
Change in type of service for CPT code 77067: Effective for Medicare claims with dates of service on or after Jan. 1, 2017, CMS has changed the type of service (TOS) indicator for Current Procedural Terminology (CPT) code 77067 (screening mammography) to “1” (medical care) instead of “4” (diagnostic radiology).
Medicare, however, didn’t adopt this code into its system until Jan. 1, 2018, to replace Healthcare Common Procedure Coding System (HCPCS) screening mammography code G0202.
Novitas Solutions will automatically reprocess previously adjudicated screening mammography claims with CPT code 77067 and a TOS code of “4” for dates of service from Jan. 1 through July 2, 2018 if the claim was denied because there was no referring provider information. If the claim was denied for any other reason, you’ll need to bring it to Novitas’ attention for reprocessing.
New voluntary modifier for advanced diagnostic imaging: CMS has created a new modifier, QQ, for appropriate use criteria program reporting on claims for advanced diagnostic imaging services with dates of service on or after July 1. Use of this modifier will be voluntary and may be:
- Used when the furnishing physician is aware of the result of the ordering physician’s consultation with a clinical decision support mechanism for that patient;
- Reported on the same claim line as the CPT code for an advanced diagnostic imaging service furnished in an applicable setting; and
- Reported on both the facility and professional claim.
CMS expects the appropriate use criteria program to be more fully implemented Jan. 1, 2020, at which time use of the QQ modifier will be required. The program is intended to encourage physicians and other health care professionals to use high-cost imaging services appropriately. For more information, see CMS’ MLN Matters No. MM10481.
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If you have questions about billing and coding or payer policies, contact the specialists at paymentadvocacy[at]texmed[dot]org for help, or call the TMA Knowledge Center at (800) 880-7955. TMA members can use the TMA Hassle Factor Log to help resolve insurance-related problems. Visit www.texmed.org/GetPaid for more resources and information.