Modifier CG

Policy criteria applied

Spinal Garments

The CG modifier must be added to the following spinal garments made primarily of non-elastic material (e.g., canvas, cotton or nylon) or has a rigid posterior panel:

  • L0450 - TLSO, flexible, provides trunk support, upper thoracic region
  • L0454 - TLSO, flexible, provides trunk support, extends from sacrococcygeal junction to above T-9 vertebra
  • L0621 - Sacroiliac Orthosis, flexible
  • L0625 - Lumbar orthosis, flexible, provides lumbar support
  • L0628 - Lumbar-sacral orthosis, flexible provides lumbo-sacral support

Hand Finger Orthoses (L3923) - Use of CG Modifier

Elastic garments do not meet the statutory definition of a brace. Code L3923 (Hand finger orthosis, without joints, prefabricated) includes both elastic and non-elastic items.

Elastic garments may be made of a variety of materials, including but not limited to neoprene or spandex (elastane, Lycra™). They are considered to be elastic even if they have flexible plastic or metal stays. If a garment made with elastic material has a rigid plastic or metal component, it is considered a non-elastic orthosis for purposes of coverage and coding.

If a hand-finger garment is made primarily of elastic material, it must be billed with code A4466 (Garment, belt, sleeve or other covering elastic or similar stretchable material, any type, each) and not code L3923. Claims billed with code A4466 will be denied as non-covered, no benefit category. Effective for claims with dates of service on or after July 1, 2010, if an L3923 orthosis has a rigid plastic or metal component, the supplier must add the CG modifier (policy criteria applied) to the code. Claims for L3923 billed without a CG modifier will be rejected as incorrect coding.

Therapeutic Continuous Glucose Monitoring Devices

For therapeutic CGM devices (code K0554) and the supply allowance (code K0553) only, the CG modifier must be added to the claim line only if all of the therapeutic CGM coverage criteria (1-6) in the Glucose Monitor Local Coverage Determination are met.

 

Last Updated Wed, 02 May 2018 12:30:18 +0000