HCPCS Modifier MB

Published 07/16/2020

Ordering professional is not required to consult a clinical decision support mechanism due to the significant hardship of insufficient internet access.

Guidelines and Instructions

  • This modifier is effective for services provided on or after January 1, 2020
  • Providers should submit this modifier with the appropriate advanced diagnostic imaging service. Examples of advanced imaging services include computed tomography, positron emission tomography, nuclear medicine and magnetic resonance imaging.
  • The ordering professional will be required to consult a qualified clinical decision support mechanism (CDSM)
  • This is an interactive, electronic tool for use by clinicians that communicates appropriate use criteria (AUC) and assists in making the most appropriate treatment decision for the patient
  • The CDSM will provide the ordering professional with a determination of whether that order adheres to AUC, does not adhere to AUC, or if there is no AUC applicable in the CDSM consulted. Exceptions to consulting CDSMs include:
    • The ordering professional having a significant hardship exception;
    • Situations in which the patient has an emergency medical condition; or
    • An applicable imaging service ordered for an inpatient and for which payment is made under Part A
  • During this phase of the program, claims will not be denied for failing to include or for misreporting AUC related information; however, inclusion is encouraged
  • Full program implementation is expected January 1, 2021


  • Change Request (CR) 11268 (PDF, 57 KB)
  • CMS MM11268 (PDF, 185 KB)

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