Reimbursement policy update - Modifier Rules (Professional)

Material Adverse Change (MAC)

 

Beginning with date of services on or after December 1, 2022, Modifier FT is allowed for reimbursement on critical care codes 99291, 99292, 99468, 99469, 99471, 99472, 99475, and 99476.

 

Modifier FT was created by the Centers for Medicare & Medicaid Services (CMS) and is included in our Claims Impacting Adjudication list located in the Related Coding section of our Modifier Rules policy (professional).

 

Modifier FT is defined as an unrelated evaluation and management (E/M) visit during a postoperative period or on the same day as a procedure or another E/M visit. (Report when an E/M visit is furnished within the global period but is unrelated, or when one or more additional E/M visits furnished on the same day are unrelated). 

 

For specific policy details, visit the reimbursement policy page at www.empireblue.com/provider.

 

NYBCBS-CM-004912-22