What is the EJ modifier used for?
Asked by: Kayley Tromp | Last update: February 23, 2025Score: 4.8/5 (44 votes)
How to bill for Durolane injection?
HCPCS code J3490 should be used to report Durolane® when billed to the Part B MAC. Durolane® has been added throughout the article.
Does CPT 20610 require a modifier?
Reporting E/M Services with 20610 CPT Code
Modifier 25 should be appended to the E/M code to indicate that it is a separately billable service. The documentation should clearly demonstrate the need for the E/M service and how it is separate from the procedure itself.
When should the KX modifier be used?
Use the KX HCPCS modifier to indicate that the clinician attests that services at and above the therapy thresholds are medically necessary and reasonable, and justification is documented in the patient's medical record.
What is the difference between modifier KX and KS?
Use modifier KX if the beneficiary is insulin treated; or, Use modifier KS if the beneficiary is non-insulin treated.
What is a Modifier in Medical Coding? CPT and HCPCS Modifiers for Beginners
What is the KX modifier for gender?
Physicians and advanced practice professionals should use modifier “KX” with procedure codes that are gender specific in the particular cases of Transgender, Ambiguous Genitalia, and Hermaphrodite patients.
Can you bill 99213 and 20610 together?
Per CCI edits, CPT codes 20610-RT and 99213-25 cannot be billed together; however a modifier is allowed with supporting documentation.
Does Medicare cover rooster comb injections?
Medicare does cover rooster comb injections, also known as hyaluronic acid injections. Doctors administer rooster comb injections to treat knee osteoarthritis, the most common form of arthritis. The hyaluronic acid injections treat knee osteoarthritis by improving lubrication and cushioning in the joint.
How do you know if a CPT code needs a modifier?
- The service or procedure has both professional and technical components.
- More than one provider performed the service or procedure.
- More than one location was involved.
- A service or procedure was increased or reduced in comparison to what the code typically requires.
What is an EJ modifier?
Billing subsequent injections in a series (EJ modifier)
A series is defined as a set of injections for each joint and each treatment. The EJ modifier must be used with the HCPCS code for the drug administered to indicate subsequent injections of a series.
Do vaccines need a JZ modifier?
In alignment with CMS guidelines, we do not require vaccines under section 1861(s) (10) (e.g. influenza, pneumococcal, COVID–19) to be reported with JW / JZ modifier.
What is the GX modifier used for?
The GX modifier is used to report that a voluntary Advance Beneficiary Notice of Noncoverage (ABN) has been issued to the beneficiary before/upon receipt of their DMEPOS item because the item was statutorily noncovered or does not meet the definition of a Medicare benefit.
How to use jz modifier?
The JZ modifier is reported to attest that no amount of drug was discarded. The JW modifier is required to be reported on a claim for the amount of drug that is discarded and eligible for payment.
Does Medicare pay for Durolane?
DUROLANE is covered by Medicare and many private insurance plans for the treatment of knee osteoarthritis pain. You can find out if your plan covers DUROLANE by calling your plan directly before initiating therapy.
How to bill 20610 for both knees?
Reporting Multiple Units
If aspirations and/or injections occur on opposite, paired joints (e.g., both knees), you may report one unit of 20610 with modifier 50 Bilateral procedure appended, per CMS instruction.
What is another name for the rooster comb injections?
A hyaluronic acid injection, also known as gel shots or HA injections, is a clear, gel-like substance that can lubricate, moisten and trap water inside joints. You may also recognize these injection treatments as viscosupplementation, rooster comb injections or chicken shots.
How much does a rooster comb shot cost?
Potential side effects of rooster comb injections include pain, swelling, and redness at the injection site. In some cases, systemic immune reactions like allergies may occur. The cost of rooster comb injections ranges between $1200 and $1800, with treatment courses potentially repeated after six months or more.
Which drugs require a jz modifier?
Effective July 1, 2023, providers and suppliers are required to report the JZ modifier on all claims that bill for drugs from single-dose containers that are separately payable under Medicare Part B when there are no discarded amounts.
What is the 59 modifier for Medicare?
Modifier 59 is used to identify procedures/services, other than Evaluation/Management services, that are not normally reported together, but are appropriate under the circumstances. XE, XS, XP, and XU are valid modifiers and provide greater reporting specificity.
What is the CPT code for Durolane injection?
HCPCS code J7318 for Hyaluronan or derivative, durolane, for intra-articular injection, 1 mg as maintained by CMS falls under Miscellaneous Drugs .
What is the kj modifier?
When billing capped rental equipment codes for Medicare members, you must use modifier KH for the first month of the rental, modifier KI for the second and third months, and modifier KJ for months four through 13.
What is the KY modifier used for?
Since the “KY” modifier indicates that the accessory is used with a non-competitively bid base unit, if the claim is billed without the “KY” modifier, claims submitted by a non-contract supplier will be denied and claims submitted by a contract supplier will be reimbursed based on the single payment amount.
What is the modifier for both legs?
Use modifier 50 to report bilateral procedures performed during the same operative session by the same physician in either separate operative areas (e.g., hands, feet, legs, arms, ears) or in the same operative area (e.g., nose, eyes, breasts).