Clarification: Modifiers for Transportation of Portable X-Rays (R0075)

Provider Types Affected
Providers billing Medicare carriers for portable x-rays

Provider Action Needed

Impact to You
This instruction provides further clarification on the use and processing of the five portable x-ray Level II Healthcare Common Procedure Coding System (HCPCS) code modifiers reportable with HCPCS code R0075 that were made effective April 1, 2005.

What You Need to Know
The five new modifiers for HCPCS code R0075 will be used to report the number of patients served during a single trip that the portable x-ray supplier makes to a particular location.

What You Need to Do
Refer to the Background and Additional Information sections of this instruction for further details regarding these changes.

Background
Previously, information on five new Level II HCPCS modifiers reportable with HCPCS code R0075 was provided by Change Request (CR) 2856, Transmittal# 14. Additional questions received by the Centers for Medicare & Medicaid Services (CMS) Regional Office indicated that there was confusion about the appropriate use of these new HCPCS modifiers.

This instruction is being issued to help answer these questions and provide further clarification on the processing of the five portable x-ray Level II HCPCS modifiers reportable with HCPCS R0075 that were made effective April 1, 2005.

Determining Single Payments
Medicare allows a single transportation payment for each trip that the portable x-ray supplier makes to a particular location. When more than one Medicare patient is x-rayed at the same location, the single fee schedule transportation payment is prorated among all the patients receiving the services.

Some contractors currently use the units field of the Medicare claim form to prorate the services to determine the appropriate single payment.

Therefore, effective upon implementation of this instruction, the five (5) new modifiers (previously implemented for HCPCS Code R0075 in CR 2856, Transmittal# 14) will be used to report the number of patients served during a single trip.

New Modifiers
HCPCS code R0075 must be billed in conjunction with the Current Procedural Terminology (CPT) radiology codes (7000 series) and only when the x-ray equipment used was actually transported to the location where the x-ray was taken. R0075 would not apply to the x-ray equipment stored in the location where the x-ray was done (e.g., a nursing home), for use as needed.

Below are the definitions for each modifier that must be reported, and only one of these five modifiers can be reported with HCPCS code R0075:

• UN - Two patients served
• UP - Three patients served
• UQ - Four patients served
• UR - Five patients served
• US - Six patients or more served

Implementation
The implementation date for this instruction is April 4, 2005.

Related Instructions
The Medicare Claims Processing Manual, Pub. 100-04, Chapter 13, “Radiology Services and Other Diagnostic Procedures,” Section 90.3, can be reviewed at the following CMS Web site: http://www.cms.hhs.gov/manuals/104_claims/clm104c13.pdf .

CR 2856, Transmittal 14, October 24, 2003, can be found at the following CMS Web site:
http://www.cms.hhs.gov/Transmittals/downloads/R14CP.pdf .

Additional Information
For further information on prorating portable x-ray transportation services, please refer to Section 90.3 in Chapter 13 of the Medicare Claims Processing Manual. The revised section is attached to the CR that was issued by CMS to your carrier.

That official instruction may be found by going to: http://www.cms.hhs.gov/Transmittals/. From that Web page, look for CR3280 in the CR NUM column on the right, and click on the file for that CR.

If you have any questions, please contact your contractor at their toll-free number, which may be found at: http://www.cms.hhs.gov/MedlearnProducts/downloads/CallCenterTollNumDirectory.pdf .

In addition, a comprehensive overview of the HCPCS can be found at the following CMS Web site: http://www.cms.hhs.gov/medicare/hcpcs/codpayproc.asp .

Disclaimer
The information contained in this article was current at the time of its development. We encourage users of this article to review statutes, regulations, and other interpretive materials for the most current information.

Additional Information Provided by Empire Medicare Services
Please Note: Empire Medicare Services is awaiting verification from CMS on the effective date for the 5 new modifiers, currently stated as April 1, 2005 . You will be informed of any revisions to the above article.

For more information, visit the Medlearn Matters Web page at: http://www.cms.hhs.gov/MedlearnMattersArticles/.

Pub. 100-4, Transmittal # 343, CR # 3280
Medlearn Matters Number: MM3280

Effective Date: April 1, 2005
Implementation Date: April 4, 2005