CT - JE Part B
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 Fri, 28 Oct 2022 20:30:45 +0000