The Centers for Medicare and Medicaid Services (CMS) issued Transmittal R1418CP, Change Request 5805, New HCPCS Modifiers when Billing for Patient Care in Clinical Research Studies, dated January 18, 2008. The instructions in this Transmittal affect PET facilities when billing Medicare for PET scans performed under the National Oncologic PET Registry (NOPR).
Specifically the instructions announce that effective for dates of service January 1, 2008, HCPCS modifier QR, currently used to identify NOPR studies when billing Medicare, is discontinued and is replaced with the new modifier Q0 (zero) – Investigational clinical service provided in a clinical research study that is in an approved research study.
The Transmittal states “Effective for dates of service on and after January 1, 2008, claims submitted with the discontinued modifier will be processed as return-to-provider / return as unprocessable.”
The instructions are to be implemented by Medicare contractors no later than April 7, 2008. Although CMS has given contractors until April 7, 2008 to implement the changes announced in this Transmittal, it is possible some contractors may do so sooner. Therefore, providers should check with their particular Medicare contractor for information on the date their systems will be ready to process claims containing the new Q0 HCPCS modifier.
Transmittal R1418CP, Change Request 5805 can be found at:
www.cms.hhs.gov/transmittals/downloads/R1418CP.pdf PDF (206 Kb)
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