New CMS Radiology Modifier “CT”

April 19, 2016 by Experian Health

Beginning in 2016, claims for CT (Computed Tomography) scans identified by the CPT codes listed  below  (and by successor codes) that are furnished on non-NEMA (National Electric Manufacturers Association) Standard XR-29-2013-compliant CT scans must include modifier “CT” that will result in an applicable payment reduction.

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

CMS Change Request (CR) 9250 informs providers that effective January 1, 2016, a payment reduction of 5 percent applies to CT services furnished on equipment that is inconsistent with the CT equipment standard and for which payment is made under the physician fee schedule.

When such payment reductions are made, MACs will supply:

  • Claim Adjustment Reason Code 237 – Legislated/Regulatory Penalty. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.)
  • Remittance Advice Remark Code N759 – Payment adjusted based on the National Electrical Manufacturers Association (NEMA) Standard XR-29-2013; and
  • Group Code: CO (contractual obligation)

The payment reduction increases 15 percent in 2017 and subsequent years. System attestation by providers will be verified through the periodic supplier accreditation process.

Read the official instruction here: https://www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/Downloads/R3402CP.pdf

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