There is a new modifier in town, and its number is 33. Because of the Patient Protection and Affordable Care Act (PPACA), there is now a requirement for health insurance plans to cover preventive services without any cost sharing (meaning no copays, coinsurance or deductibles applying).

The reporting of new modifier –JW, which specifies the portion of a single dose vial (SDV) or single use package that was not administered to the patient, and which goes into effect July 30, 2010, is optional at this time.  

Medicare guidelines state to report the drug amount administered on one line, and on a separate line you may report the amount of drug NOT administered (wasted) with modifier –JW appended to the associated HCPCS code.

On April 5, 2010, CMS revised the Advance Beneficiary Notice of Noncoverage (ABN) modifiers. The purpose of the new modifiers is to differentiate between voluntary and mandatory use of the liability notice.

The new modifiers are:

-GA –Waiver of Liability Statement Issued as Required by Payer Policy

-GX – Notice of Liability Issued, Voluntary under Payer Policy

In part 1 of this modifier series we identified and discussed the largest category—Global Package Modifiers, and the following modifier categories: GP, BUN, E/M only, #, Anes, Lab, and OTH. In part 2, we will explore the other categories of modifiers starting with the “BUN” grouping. 

The following are the modifiers that relate to the bundling of CPT codes or related CCI edits:

CMS has decided there is no longer a need to distinguish between diagnostic and therapeutic clinical trial services. This decision by CMS goes into effect July 10, 2009 and applies to all claims submitted with dates of service on or after January 1, 2008. The ICD-9 diagnosis code of V70.7 is still required to be reported on all claims that were submitted with either the QV or Q1 modifier.