MLN Matters. . .Information for Medicare Providers
(Issued by the Centers for Medicare & Medicaid Services)
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Clarification:
Modifiers for Transportation of Portable X-Rays
(R0075)
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Note: This article was
revised on November 15, 2004 to show the correct
effective date for the modifiers reportable for
R0075.
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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 January 1, 2004.
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 January 1, 2004.
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.
| This results in inconsistencies in the
reporting of these services among providers and
carriers, and inflates the national frequency data
based on the units field for these
services. |
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
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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
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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
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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
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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.
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: January 1, 2004
Implementation Date: April 4, 2005
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