HCPCS Modifier ME
Published 07/16/2020
Description
The order for this service adheres to the appropriate use criteria in the clinical decision support mechanism consulted by the ordering professional.
Guidelines and Instructions
The order for this service adheres to the appropriate use criteria in the clinical decision support mechanism consulted by the ordering professional.
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
- Claims that report HCPCS modifier ME should additionally contain a separate line item with the appropriate HCPCS G code (G1000–G1011) to report which qualified CDSM was consulted. Note, HCPCS code G1000 was deleted for dates of service April 1, 2020, and after.
- HCPCS codes G1000–G1011 are for reporting and not payable. The following remittance messages will be used:
- CARC 246
- RARC N620
- Group Code CO (Contractual Obligation)
- 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
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