(Medicare Claims Processing Manual)

Below are the definitions for each modifier that must be reported with R0075.  Only one of these five modifiers shall be reported with R0075.  NOTE : If only one patient is served, R0070 should be reported with no modifier since the descriptor for this code reflects only one patient seen.   UN -  Two patients served UP - Three patients served  UQ -  Four patients served  UR -  Five Patients served  US - Six or more patients served   Payment for the above modifiers must be consistent with the definition of the modifiers.  Therefore, for R0075 reported with modifiers, - UN, - UP, - UQ, and UR, the total payment for the service shall be divided by 2, 3, 4, and 5 respectively.  For modifier  US, the total payment for the service shall be divided by 6 regardless of the number of patients served.  For example, if 8 patients were served, R0075 would be reported with modifier US and the total payment for this service would be divided by 6.   The units field for R0075 shall always be reported as 1 except in extremely unusual cases.  The number in the units field should be completed in accordance with the provisions of 100- 04, chapter 23, section 10.2 item 24 G which defines the units field as the number of times the patient has received the itemized service during the dates listed in the from/to field.  The units field must never be used to report the number of patients served during a single trip.  Specifically, the units field must reflect t he number of services that the specific beneficiary received, not the number of services received by other beneficiaries.   As a contractor priced service, MACs must initially determine a payment rate for portable x-ray transportation services that is associated with the cost of providing the service. In order to determine an appropriate cost, the MAC should, at a minimum, cost  out the vehicle, vehicle modifications, gasoline and the staff time involved in only the transportation for a portable x- ray service. A review of the pricing of this service should be done every five years.   Direct costs related to the vehicle carrying the x -ray machine are fully allocable to determining the payment rate. This includes the cost of the vehicle using a recognized depreciation method, the salary and fringe benefits associated with the staff who drive the vehicle, the communication equipment used between the vehicle and the home office, the salary and fringe benefits of the staff who determine the vehicles route (this could be proportional of office staff), repairs and maintenance of the vehicle(s) , insurance for the vehicle(s), operating expenses for the vehicles and any other reasonable costs associated with this service as determined by the MAC.  The MAC will have discretion for allocating indirect costs (those costs that cannot be directly attributed to portable x- ray transportation) between the transportation service and the technical component of the x-ray tests.   Suppliers may send MACs unsolicited cost information. The MACs may use this cost data as a comparison to its contractor priced determination. The data supplied should reflect a years worth (either calendar or corporate fiscal) of information. Each provide r who submits such data is to be informed that the data is subject to verification and will be used to supplement other information that is used to determine Medicares payment rate.   The MACs are required to update the rate on an annual basis using independently determined measures of the cost of providing the service. A number of readily available measures (e.g., ambulance inflation factor, the Medicare economic index) that are used by the Medicare program to adjust payment rates for other types of services may be appropriate to use to update the rate for years that the MAC does not recalibrate the payment. Each MAC has the flexibility to identify the index it will use to update the ra te. In addition, the MAC can consider locally identified factors that are measured independently of CMS as an adjunct to the annual adjustment.  NOTE: No transportation charge is payable unless the portable x- ray equipment used was actually transported to the location where the x -ray was taken.  For example, MACs do not allow a transportation charge when the x- ray equipment is stored in a nursing home for use as needed.  However, a set -up payment (see 90.4, below) is payable in such situations.  Further, for services furnished on or after January 1, 1997, MACs may not make separate payment under HCPCS code R0076 for the transportation of EKG equipm ent by portable x- ray suppliers or any other entity.  90.4 - Set-Up Component (HCPCS Code Q0092)  (Rev. 1, 10- 01-03)  A/B MACs (B) must pay a set -up component for each radiologic procedure (other than retakes of the same procedure) during both single patient and multiple patient trips under Level II HCPCS code Q0092.  A/B MACs (B) do not make the set -up payment for EKG services furnished by the portable x- ray supplier.   90.5 - Transportation of Equipment Billed by a SNF to a MAC  (Rev. 3230, Issued: 04- 03-15, Effective: 06 -15-15, Implementation: 06- 15-15)  When a SNF bills for portable x- ray equipment transported to a site by van or other vehicle, the SNF should bill for the transportation costs using one of the following HCPCS codes along with the appropriate revenue code:   Code  Description  R0070  Transportation of Portable x -ray Equipment and Personnel to Home or Nursing Home, Per Trip to Facility or Location, One Patient Seen.  R0075  Transportation of Portable x -ray Equipment and Personnel to Home or Nursing Home, Per Trip to Facility or Location, More than One Patient Seen, Per Patient.   These HCPCS codes are subject to the fee schedule.   Effective April 1, 2006, SNFs are required to report the appropriate modifiers to identify the number of patients served when billing for R0075.  See section 90.3, of this chapter for the list of modifiers used to identify on the claim the number of patients served.   MACs shall ensure that payment for R0075 is consistent with the definition of the modifiers.   NOTE:  When a SNF resident receives a portable x -ray service during the course of a Medicare- covered stay in the SNF, only the services professional component (representing the physicians interpretation of the test results) is a separately billable physician se rvice under Part B (see 20.1 of this chapter and 20.1.1 of Chapter 6).  By contrast, the technical component representing the procedure itself, including any associated transportation and setup costs, would be subject to consolidated billing (the SNF bundling requirement for services furnished to the SNFs Part A residents), and must be included on the SNFs Part A bill for the residents covered stay (Bill Type 21x) rather than being billed separately under Part B (see 20.2.1of this chapter).  100 - Interpretation of Diagnostic Tests  (Rev. 1, 10- 01-03)  100.1 - X-rays and EKGs Furnished to Emergency Room Patients  (Rev. 1, 10- 01-03)  The professional component of a diagnostic procedure furnished to a beneficiary in a hospital includes an interpretation and written report for inclusion in the beneficiarys medical record maintained by the hospital.  (See 42 CFR 415.120(a) .)  A/B MACs (B) generally distinguish between an interpretation and report of an x- ray or an EKG procedure and a review of the procedure.  A professional component billing based on a review of the findings of these procedures, without a complete, written report similar to that which would be prepared by a specialist in the field, does not meet the conditions for separate payment of the service. This is because the review is already included in the emergency department evaluation and management (E/M) payment.  For example, a notation in the medical records saying fx- tibia or EKG -normal would not suffice as a separately payable interpretation and report of the procedure and should be  considered a review of the findings payable through the E/M code.  An interpretation and report should address the findings, relevant clinical issues, and comparative data (when available).   Generally, A/B MACs (B) must pay for only one interpretation of an EKG or x- ray procedure furnished to an emergency room patient.  They pay for a second interpretation (which may be identified through the use of modifier  -77) only under unusual circumsta nces (for which documentation is provided) such as a questionable finding for which the physician performing the initial interpretation believes another physicians expertise is needed or a changed diagnosis resulting from a second interpretation of the results of the procedure.   When A/B MACs (B) receive only one claim for an interpretation, they must presume that the one service billed was a service to the individual beneficiary rather than a quality control measure and pay the claim if it otherwise meets any applicable reasonabl e and necessary test.   When A/B MACs (B) receive multiple claims for the same interpretation, they must generally pay for the first bill received. A/B MACs (B) must pay for the interpretation and report that directly contributed to the diagnosis and treatment of the individual patient.  Consideration is not given to physician specialty as the primary factor in deciding which interpretation and report to pay regardless of when the service is performed. Consideration is not given to designation as the hospitals official interpret ation as a factor in determining which claim to pay.  A/B MACs (B) pay for the interpretation billed by the cardiologist or radiologist if the interpretation of the procedure is performed at the same time as the diagnosis and treatment of the beneficiary.   (This interpretation may be an oral report to the treating physician that will be written at a later time.)   If the first claim received is from a radiologist, A/B MACs (B) generally pay the claim because they would not know in advance that a second claim would be forthcoming.  When A/B MACs (B) receive the claim from the emergency room (ER) physician and can identify that the two claims are for the same interpretation, they must determine whether the claim from the ER physician was the interpretation that contributed to the diagnosis and treatment of the patient and, if so, they pay that claim.  In such cases, A/ B MACs (B) must determine that the radiologists claim was actually quality control and institute recovery action.  The two parties should reach an accommodation about who should bill for these interpretations.  The following examples apply to A/B MACs (B):   EXAMPLE A:   A physician sees a beneficiary in the ER on January 1 and orders a single view chest x-ray.  The physician reviews the x- ray, treats, and discharges the beneficiary.  An A/B MAC (B) receives a claim from a radiologist for CPT code 71010- 26 indicating an interpretation with written report with a date of service of January 3.  The A/B MAC (B) will pay the radiologists claim as the first bill received.  A/B MACs (B) do not have to develop the claim to determine whether the interpretation was a quality control  service.   EXAMPLE B:   Same circumstances as Example A, except that the physician who sees the beneficiary in the ER also bills for CPT code 71010- 26 with a date of service of January 1.  The A/B MAC (B) will pay the first claim received.  If the first claim is from the treating phys ician in the ER, and there is no indication the claim should not be paid, e.g., no reason to think that a complete, written interpretation has not been performed, payment of the claim is appropriate.  The A/B MAC (B) will deny a claim subsequently received from a radiologist for the same interpretation as a quality control service to the hospital rather than a service to the individual beneficiary.   EXAMPLE C:   Same as Example B except that the claim from the radiologist uses modifier  -77 and indicates that, while the ER physicians finding that the patient did not have pneumonia was correct, there was also a suspicious area of the lung suggesting a tumor that required further testing.  In such situations, the A/B MAC (B) pays for both claims under the fee schedule.   EXAMPLE D:   The A/B MAC (B) receives separate claims for CPT code 71010 -26 from a radiologist and a physician who treated that patient in the ER, both with a date of service of January 1.  The first claim processed in the system is paid and the second claims will be i dentified and denied as a duplicate.  If the denied provider is the radiologist and he raises an issue the A/B MAC (B) will develop the claim to determine whether the findings of the radiologists interpretation were conveyed to the treating physician (orally or in writing) in time to contribute to the diagnosis and treatment of the patient. If the radiologists interpretation was furnished in time to serve this purpose, that claim should be paid, and the claim from the other physician should be denied as  not reasonable and necessary.   110 - Special Billing Instructions for Claims Submitted to A/B MACs (A) (Rev. 1, 10- 01-03)