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Luke Bell
Luke Bell

Fm 2007 Modifier 2.14 EXCLUSIVE

Medicare payments for durable medical equipment (DME), such as wheelchairs, are subject to a value modifier when the DME is not of a type covered by a durable medical equipment (DME) beneficiary fee schedule (DME-BFS).

fm 2007 modifier 2.14

A payment modifier for medication administration to optimize treatment outcomes. This modifier is applicable to services billed to Medicare for the day of medication administration (i.e., on the same day as medication administration) and other day of services.

In February 2013, CMS provided supplemental guidance on the use of the information in the Quality and Resource Use Reports (QRURs) to calculate, and pay, various modifiers for Medicare Part B services that are not reported by the date, time, and duration of the services in the medical claims. These modifications also apply to claims for payments for services as of January 1, 2015.

The burden is upon the provider to affirmatively and continuously indicate the days or hours the physician is not available for service, including vacation, holidays, vacations, and weekends. Service hours are counted in the same way as they are counted for patients. If a provider does not provide service-time, the corresponding modifier is zero. A zero modifier is not the equivalent of a negative modifier.

The payment adjustment is a reduction in payment for services rendered outside of the physician's usual scope of service. The adjustment factor of 10.0% is applicable to services billed and paid outside of the usual scope of service (e.g., the application of the Adjusted Value Modifier across the usual scope of service).


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