Modifier CT

Effective for services provided on/after January 1, 2016, computed tomography (CT) imaging furnished using equipment that does not meet each of the attributes of the National Electrical Manufacturers Association (NEMA) XR-29-2013 standard.

Correct Use

  • If equipment does not meet National Electrical Manufacturers Association (NEMA) XR-29-2013 standard, append modifier to codes below.
    • 70450, 70460, 70470, 70480, 70481, 70482, 70486, 70487, 70488, 70490, 70491, 70492, 70496, 70498, 71250, 71260, 71270, 71275, 72125, 72126, 72127, 72128, 72129, 72130, 72131, 72132, 72133, 72191, 72192, 72193, 72194, 73200, 73201, 73202, 73206, 73700, 73701, 73702, 73706, 74150, 74160, 74170, 74174, 74175, 74176, 74177, 74178, 74261, 74262, 74263, 75571, 75572, 75573, 75574
  • Payment Reduction
    • 2016: Reduction was 5 percent
    • 2017 and after: Reduction is 15 percent
    • Only applies to technical component and technical component of global fee of computed radiography services
    • Applies under both Medicare Physician Fee Schedule (MPFS) and Outpatient Prospective Payment System (OPPS)

Example Correct Use

Date Treatment Code/Modifier Billed Allowed Payment
12/15/17 CT head and brain without contrast materials 70450 TC CT 95.00 85.00 85.00
-12.75 (15%)
57.80 (80%)
12/15/17 CT head and brain without contrast materials 70450 26 50.00 45.00 36.00

 

Example Incorrect Use

Date Treatment Code/Modifier Billed Allowed Payment
12/15/17 CT head and brain without contrast materials 70450 CT 145.00 130.00 130.00
- 19.50 15%)
110.50

Resource

 

Last Updated Tue, 20 Apr 2021 15:23:57 +0000