Effective immediately, LT and RT modifiers may not be entered on the same service line of an Orthotic and Prosthetic (O&P) electronic Treatment Authorization Request (eTAR). Any O&P eTAR submitted with both LT and RT modifiers on the same service line will be deferred by the field office to the provider for correction.

This eTAR modification is the result of the federally mandated National Correct Coding Initiative (NCCI), which is generating changes to the Medi-Cal claims processing system, which in turn is requiring changes to use of NCCI-associated modifiers.

Medi-Cal will apply NCCI edits to claims processed on or after March 28, 2011, with dates of service on or after October 1, 2010.

Previously Submitted eTARs with No Claims and Partial Claims Paid
All O&P eTARs submitted after October 1, 2010 with both the LT and RT modifiers on the same service line and units left unpaid, must be canceled. Providers must submit a new eTAR with the modifiers split over multiple lines and the text “TAR being resubmitted for remaining units and modifiers to comply with NCCI” and the previously approved TAR Control Number in the Misc TAR Information section.

NCCI Information
For additional information providers may refer to the downloadable National Correct Coding Initiative Policy Manual for Medicaid Services and to the new NCCI area on the Medi-Cal website.