Commonwealth of Massachusetts Executive Office of Health and Human Services Office of Medicaid www.mass.gov/masshealth MassHealth Transmittal Letter CHC-97 May 2013 TO: Community Health Centers Participating in MassHealth FROM: Julian J. Harris, M.D., Medicaid Director RE: Community Health Center Manual (New Modifiers for National Correct Coding Initiatives) This letter transmits updates to Subchapter 6 in the Community Health Center Manual. MassHealth has also expanded the list of allowable modifiers for use with MassHealth-covered service codes, as described in All Provider Bulletin 227 (June 2012). The revised Subchapter 6 is effective for dates of service on or after July 1, 2012. MassHealth Website This transmittal letter and attached pages are available on the MassHealth website at www.mass.gov/masshealth. Questions If you have any questions about this transmittal letter, please contact MassHealth Customer Service at 1-800-841-2900, e-mail your inquiry to providersupport@mahealth.net, or fax your inquiry to 617-988-8974. NEW MATERIAL (The pages listed here contain new or revised language.) Community Health Center Manual Pages 6-15 and 6-16 OBSOLETE MATERIAL (The pages listed here are no longer in effect.) Community Health Center Manual Pages 6-15 and 6-16 — transmitted by Transmittal Letter 95 Commonwealth of Massachusetts MassHealth Provider Manual Series Subchapter Number and Title 6. Service Codes and Descriptions Page 6-15 Community Health Center Manual Transmittal Letter CHC-97 Date 07/01/12 613 Payable Behavioral Health Screening Tool Service Codes (cont.) Service Code Modifier Special Requirement or Limitation 96110 U6 Covered for members birth to 21 for the administration and scoring of a standardized behavioral health screening tool from the approved menu of tools found in Appendix W of your MassHealth provider manual; and behavioral health need identified* (Eligible providers are nurse practitioners employed by community health centers.) 96110 U7 Covered for members birth to 21 for the administration and scoring of a standardized behavioral health screening tool from the approved menu of tools found in Appendix W of your MassHealth provider manual; with no behavioral health need identified* (Eligible providers are physician assistants employed by community health centers.) 96110 U8 Covered for members birth to 21 for the administration and scoring of a standardized behavioral health screening tool from the approved menu of tools found in Appendix W of your MassHealth provider manual; and behavioral health need identified* (Eligible providers are physician assistants employed by community health centers.) * “Behavioral health need identified” means the provider administering the screening tool, in his or her professional judgment, identifies a child with a potential behavioral health services need. 614 Modifiers The following service code modifiers are allowed for billing under MassHealth. Modifier Description 24 Unrelated evaluation and management service by the same physician during post operative period. 25 Significant, separately identifiable evaluation and management service by the same physician or other qualified health care professional on the same day of the procedure or other service. 26 Professional Component 50 Bilateral procedure 51 Multiple procedures 54 Surgical care only 57 Decision for Surgery 58 Staged or related procedure or service by the same physician or other qualified health care professional during the postoperative period. 59 Distinct procedural service. 62 Two surgeons 66 Surgical team 78 Unplanned return to the operating/procedure room by the same physician or other qualified health care professional following initial procedure for a related procedure during the postoperative period. 79 Unrelated procedure or service by the same physician or other qualified health care professional during the postoperative period. Commonwealth of Massachusetts MassHealth Provider Manual Series Subchapter Number and Title 6. Service Codes and Descriptions Page 6-16 Community Health Center Manual Transmittal Letter CHC-97 Date 07/01/12 614 Modifiers (cont.) Modifier Description 80 Assistant surgeon 82 Assistant surgeon (when qualified resident surgeon not available) 91 Repeat clinical diagnostic laboratory test. 99 Multiple modifiers LT Left side (used to identify procedures performed on the left side of the body). RT Right side (used to identify procedures performed on the right side of the body). TC Technical Component The following modifiers are for Provider Preventable Conditions that are National Coverage Determinations Modifier Description PA Surgical or other invasive procedure on wrong body part PB Surgical or other invasive procedure on wrong patient PC Wrong surgery or other invasive procedure on patient For more information on the use of these modifiers, see Appendix V of your provider manual. This publication contains codes that are copyrighted by the American Medical Association. Certain terms used in the service descriptions for HCPCS codes are defined in the Current Procedural Terminology (CPT) code book.