99 - JD DME

Modifier overflow

Instructions

When more than four modifiers are required to describe a service on the same code, replace the fourth modifier with modifier 99.

Correct Use

• Replace fourth modifier with modifier 99 in Item 24D of CMS-1500 claim form or its electronic equivalent
• Reflect only overflow modifiers in Item 19 of CMS-1500 claim form or its electronic equivalent
• Documentation must explain all modifiers appended
• Includes informational and pricing modifiers
• Certain modifiers may affect payment

Incorrect Use

• In this situation, do not append other modifiers in Item 24D of CMS-1500 claim form or its electronic equivalent

Resource

• CMS Internet Only Manual (IOM), Publication 100-04, Medicare Claims Processing Manual, Chapter 26