HCPCS Modifier CT

Description
CT equipment does not meet NEMA standards.

Guidelines

  • This modifier is effective for services provided on or after January 1, 2016
  • Providers must submit this modifier with the following CPT codes for each service that meets the criteria under description, above
     70450–70498
     71250–71275
     72125–72133
     72191–72194
     73200–73206
     73700–73706
     74150–74178
     74261–74263
     75571–75574
  • Beginning in 2016, a payment reduction of five percent applies to the technical component (and the technical component of the global fee) for CT services furnished using equipment that is inconsistent with the CT equipment standard and for which payment is made under the physician fee schedule. This payment reduction becomes 15 percent for 2017 and succeeding years.
  • Use of HCPCS modifier CT for these services will result in the applicable payment reduction
  • When these payment reductions are made, the following remittance messages will be used:
    • Claim Adjustment Reason Code 237 — Legislated/Regulatory Penalty. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an alert).
    • Remittance Advice Remark Code N759 — Payment adjusted based on the National Electrical Manufacturers Association (NEMA) Standard XR-29-2013; and
    • Group Code: CO (contractual obligation)

Reference: CMS MLN Matters article MM9250 (PDF, 79 KB).

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