HCPCS Modifier MH

Published 07/16/2020

Unknown if ordering professional consulted a clinical decision support mechanism for this service; related information was not provided to the furnishing professional or provider.

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
  • 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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