HCPCS Modifier MB
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