Medical Billing and Coding Healthcare Blog

In an MLN Matters article published late last year, the Centers for Medicare & Medicaid Services (CMS) discussed the creation of modifier -CT (computed tomography services furnished using equipment that does not meet each of the attributes of the National Electrical Manufacturers Association (NEMA) XR-29-2013 standard).

Effective for claims submitted on or after January 1, 2016, CMS now requires the use of -CT for applicable CT scans furnished on non-NEMA Standard XR-29-2013-compliant equipment. Providers must append it to codes for CT scans on services furnished on equipment that do not adhere to this NEMA standard.

The codes are as follows:

  • 70450–70498
  • 71250–71275
  • 72125–72133
  • 72191–72194
  • 73200–73206
  • 73700–73706
  • 74150–74178
  • 74261–74263
  • 75571–75574
  • Successor codes

According to the American College of Radiology (ACR), CT scanners meeting the XR-29 standard have the following:

  • DICOM-compliant radiation dose structured reporting
  • Dose check features
  • Automatic exposure control
  • Reference adult and pediatric protocols

As CMS notes, a payment reduction of 5% will apply to CT services furnished using equipment that is inconsistent with the CT equipment standard and for which payment is made under the physician fee schedule. The payment reduction increases to 15% in 2017 and subsequent years.

For more information on modifier -CT, see the following:

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The Centers for Medicare & Medicaid Services (CMS) has issued a reminder to organizations concerning Medicare payment for positive airway pressure (PAP) devices.

CMS notes that the Social Security Act prohibits payment for devices used to deliver continuous and/or bi-level PAP as items requiring frequent and substantial servicing, regardless of the illness the device is being used to treat.

Claims submitted for payment for such devices will be denied.

CMS goes on to state that using HCPCS codes E0450, E0460, E0461, E0463, E0464, E0465 or E0466 on a Medicare claim for a device to deliver PAP to a beneficiary is not allowed and could potentially violate the False Claims Act, even if the same device could be used as a ventilator for a different beneficiary.