Modifier QJ

Service/items provided to a prisoner or patient in state or local custody, however the state or local government, as applicable, meets the requirement in 42 CFR 411.1(B)

Correct Use

  • Append to Medicare claims in below situations where Medicare will make payment for individuals who are in custody.
    • Per 42 CFR 411.4(b), "Payment may be made for services furnished to individuals or groups of individuals who are in the custody of the police or other penal authorities or in the custody of a government agency under a penal statute only if the following conditions are met"
      • State or local law requires those individuals or groups of individuals to repay the cost of medical services they receive while in custody, and
      • The State or local government entity enforces the requirement to pay by billing all such individuals, whether or not covered by Medicare or any other health insurance, and by pursuing the collection of the amounts they owe in the same way and with the same vigor that it pursues the collection of other debts."



Last Updated Sep 30 , 2022