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HIPAA Conversion for Non-Physician Medical Practitioner Modifiers

December 5, 2008

Effective for dates of service on or after February 1, 2009, local Non-physician Medical Practitioner (NMP) modifiers AN, YU, YR and YT will be replaced with national HCPCS and CPT-4 modifiers to comply with HIPAA. The updates are as follows:

Previous
Modifier
Previous Modifier
Description
National
Modifier
National Modifier
Description
Billing
Instructions
AN
Physician Assistant service
U7
Medicaid Level of Care 7, as defined by each state NPI of the supervising physician must be entered in the rendering physician section and the NMP name, NPI and type of NMP must be entered in the Remarks field
(Box 80)/ Reserved for local use field (Box 19) of the appropriate claim form.
YU
Physician Assistant service (multiple modifiers)
99

U7
Multiple Modifiers

Medicaid Level of Care, as defined by each state (listed in the Remarks field)


Enter the applicable procedure code with modifier 99 in the Procedures, Services, or Supplies field (Box 24D). In the Remarks field.

(Box 80)/Reserved for Local Use field (Box 19) enter “99 = Modifier U7 + [additional modifiers as appropriate].”
YR
Certified Nurse Midwife service (multiple modifiers) (when billed by a physician, organized outpatient clinic or hospital outpatient department)
99

SB
Multiple Modifiers

Nurse midwife (listed in Remarks field)
Enter the applicable procedure code with modifier 99 in the Procedures, Services, or Supplies field (Box 24D).

In theRemarks field (Box 80)/Reserved for Local Use field (Box 19) enter “99 = SB + [additional modifiers as appropriate].”

YT
Nurse Practitioner service (multiple modifiers)
99

SA
Multiple Modifiers

Nurse Practitioner rendering service in collaboration with a physician (listed in Remarks field)
Enter the applicable procedure code with modifier 99 in the Procedures, Services, or Supplies field (Box 24D).

In the Remarks field (Box 80)/Reserved for Local Use field (Box 19) enter “99 = SA + [additional modifiers as appropriate].”

The policy for each modifier will be transferred to its respective replacement modifier. The multiple modifiers used must be explained in the Remarks field (Box 80)/Reserved for Local Use field (Box 19) of the claim.

Claims with local NMP modifiers AN, YU, YR and YT will be denied for dates of service on or after February 1, 2009. Providers are also reminded that local modifier YS was end-dated effective October 2005. Claims billed with modifier YS will also be denied. Manual pages reflecting this policy will be released in a future Medi-Cal Update.