What are Medicaid modifiers?


Quick Answer

Modifiers are data codes that identify and report the Medicaid programs offered by a state, according to the definition provided by the Texas Medicaid & Healthcare Partnership. Some modifiers affect the processing and reimbursement of claims, while others are purely descriptive, states ForwardHealth, the Wisconsin state Medicaid management organization.

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Full Answer

In its online manual, Texas Medicaid defines a few commonly used modifiers, such as for emergency ambulance service, or ET for "emergency transport," and for instances where a Medicaid recipient's visit to a medical provider coincides with other services that may be separately listed, coded as "25" in Texas. All current modifiers accepted nationwide are accepted by Wisconsin, claims ForwardHealth.

To create a more unified and portable coding system, Medicaid.gov reports that the National Correct Coding Initiative, or NCCI, was launched along with the Affordable Care Act. The Affordable Care Act of 2010 requires all 50 states to conform to NCCI methodologies for processing claims. NCCI methods compare state-processed Medicaid claims to codes listed in the Healthcare Common Procedure Coding System, or HCPCS, to determine whether to accept or deny a claim. The NCCI editing methodology means to foster uniform coding nationwide and control improper coding that leads to improper payment of claims, explains the Centers for Medicare & Medicaid Services. However, the Medicaid NCCI coding methods are appreciably different programs, cautions Medicaid.gov.

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