Monday, April 18, 2011

Code/Modifier Combination Invalid and Modifier Invalid/Missing - B18,CO4, MA130




Remark Code/ Message Number:

• B18: Payment adjusted because this procedure code and modifier were invalid on the date of service

• 4: The procedure code is inconsistent with the modifier used or a required modifier is missing

• MA130: Your claim contains incomplete and/or invalid information, and no appeal rights are afforded because the claim is unprocessable. Please submit a new claim with the complete/correct information.

Resolution

• Review the CPT/HCPCS code narratives to determine if a modifier is needed

• Verify that the submitted modifier is appropriate to be submitted with the procedure code

• Access complete instructions for correctly submitting all CPT and HCPCS modifiers on the 'Palmetto GBA Modifier Lookup' Web page:

o Jurisdiction 1: Select 'Articles' on the left side of the Palmetto GBA Web page

o Ohio, South Carolina and West Virginia: Select 'Browse by Topic' on the left side of the Palmetto GBA Web page.
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Medicare physician fee schedule - Quick overview

Medicare Part B pays for physician services based on the PFS, which lists the more than 7,400 unique
covered services and their payment rates. Physicians’ services include the following:

* Office visits;
* Surgical procedures;
* Anesthesia services; and
* A range of other diagnostic and therapeutic services.


Medicare Physician Fee Schedule Payment Rates

Payment rates for an individual service are based on
three components:
1) Relative Value Units (RVU)
2) Conversion Factor (CF)
3) Geographic Practice Cost Indices (GPCI)


Medicare Physician Fee Schedule Payment Rates Formula


The Medicare PFS payment rates formula is shown below:

[(Work RVU x Work GPCI) + (PE RVU x PE GPCI) +
(MP RVU x MP GPCI)] x CF

Medicare fee schedule download