Janice,
I was able to find the following information and webinar very helpful. The webinar give good hypothetical complex patient cases that are seen by various physician specialties as part of their treatment and follow up plans. The webinar slide deck and recording can be found at the following link.
https://www.cms.gov/medicare/quality-initiatives-patient-assessment-instruments/value-based-programs/macra-mips-and-apms/macra-feedback.html
Additionally, I have attached a recent mln matters notification.
The codes are currently in a voluntary reporting period. Whether and how the codes are reported on claims will not affect Medicare reimbursement. For now, the modifiers have no impact on beneficiaries.
Reporting of these modifiers will be mandatory in the near future and CMS advises clinicians to participate during the voluntary reporting period to ease transition.
It appears as though radiology will use the X5 modifier that defines Only as Ordered by Another Clinician for their diagnostic imaging cases. Interventionalists may also use the X4 modifier that defines an Episodic/Focused Services.
These modifiers are placed on box 24d of the CMS 1500 form next to each CPT/HCSPCS code on each line.
PC Service Example: 70450 26 X5
Thanks,
Greg
Gregory D. Wertz, MS
Director of Industry Research and Relations
Practice Manager
MBMS, LLC
3048 Enterprise Drive
State College, PA 16801
Office: 877-235-7686 ext. 974
Mobile: 814-203-0088
www.mbms.net
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