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PA U Code Moifiers for 92507

nicholas Posted Sat 13th of June, 2020 07:52:05 AM
What are the U Code Modifier Definitions for Pennsylvania Medicaid CPT Code 92507 (Speech Tx) U3, u4, u9, and ub. Use this link to see the fee schedule but no definitions are attached. https://www.humanservices.state.pa.us/OUTPATIENTFEESCHEDULE/Home/Details?provType=17&modCode;= &specCode=173&procCode=92507&pos=99&amt=21.70&begin=07/01/2004&end=12/31/2299 ***Click on show fee history***
SuperCoder Answered Mon 15th of June, 2020 03:28:42 AM

Hi Nicholas,

Please find below the details of the modifiers:

 

U3 Modifier:

 

Description: Medicaid level of care 3, as defined by each state

 

Lay Term: A provider appends modifier U3 to report the services related to a Medicaid level of care 3, as defined by each state. The level of care may relate to the amount of assistance a patient requires, or the complexity of care. A state may also use this code to have the provider identify a type of service or patient situation. See state specific requirements for use of this code.

A provider appends modifier U3 according to their state specific requirements. The code often defines a tiered service based upon complexity of care but a provider may need to apply the modifier to identify a type of service or situation such as a health care home programs, comprehensive care, coordination and planning, and initial plan; or skilled nursing services A or B level of care. A provider may use this code for a mental health services encounter when he performs a behavioral health screening or evaluation of a patient. Identification of behavioral health need means that the provider, who is evaluating the patient, identifies a patient who is typically a child with a significant or potential behavioral health services need.

 

U4 Modifier:

 

Description: Medicaid level of care 4, as defined by each state

 

Lay Term: A provider appends modifier U4 to report the services related to a Medicaid level of care 4, as defined by each state. The level of care may relate to the amount of assistance a patient requires, or the complexity of care. A state may also use this code to have the provider identify a type of service or patient situation. See state specific requirements for use of this code.

A provider appends modifier U4 according to their state specific requirements. A provider may use this code when he identifies any behavioral health need during screening or evaluation of a patient. Identification of behavioral health need means that the provider, who is evaluating the patient, identifies a patient who is a child with a significant or potential behavioral health services need.

 

U9 Modifier:

 

Description: Medicaid level of care 9, as defined by each state

 

Lay Term: A provider appends modifier U9 to report the services related to a Medicaid level of care 9, as defined by each state. The level of care may relate to the amount of assistance a patient requires, or the complexity of care. A state may also use this code to have the provider identify a type of service or patient situation. See state specific requirements for use of this code.

A provider appends modifier U9 according to their state specific requirements. The code often defines a tiered service based upon complexity of care but a provider may need to apply the modifier to identify a type of service or situation such as a health care home programs, comprehensive care, coordination and planning, and initial plan; or for such services as when he evaluates, diagnoses, and treats patients with vision problems, for example.

 

UB Modifier:

 

Description: Medicaid level of care 11, as defined by each state

 

Lay Term: A provider appends modifier UB to report the services related to a Medicaid level of care 11, as defined by each state. The level of care may relate to the amount of assistance a patient requires, or the complexity of care. A state may also use this code to have the provider identify a type of service or patient situation. See state specific requirements for use of this code.

A provider appends modifier UB according to their state specific requirements. The code often defines a tiered service based upon complexity of care but a provider may need to apply the modifier to identify a type of service or situation such as identifying that a transport is of a critically ill or injured patient over 24 months of age. The UB modifier can also indicate that the age of the patient is less than 21 or greater than 59, as for some Vision care services.

 

Thanks!

nicholas Posted Mon 15th of June, 2020 05:37:26 AM
Hi we were able to find that much. Now I would like the actual description for pa for level u3 for 92507.
SuperCoder Answered Tue 16th of June, 2020 05:14:10 AM

Hi Nicholas,

 

Description would be Individual Service for PA for level U3 for 92507.

 

Please find below link from Medicaid more understanding:

 

https://www.dhs.pa.gov/providers/Documents/School-Based ACCESS Program/C_291738.pdf

 

Thanks!

nicholas Posted Wed 01st of July, 2020 11:46:34 AM
This is the school based definition. We are looking for the outpatient (office 11) and specialty therapist (17). Specifically to the following. Should I buy another question? Our specialty is Therapist 17 Location is Office 11 Procedure Code 92507 U3 Modifier - U4 Modifier - U9 Modifier - UB Modifier - Procedure Code 92530 U3 Modifier - U7 Modifier - U8 Modifier -
SuperCoder Answered Thu 02nd of July, 2020 12:02:06 PM

Hi,

 

This query is under review. We are working on it and will update you soon.

 

We thank you for your cooperation!

 

SuperCoder Answered Thu 09th of July, 2020 02:10:27 AM

Hi Nicholas,

 

Unfortunately, we are unable to answer this question.  We do not have access to state-specific Medicaid regulations.  We advise you to contact your Medicaid Representative to further inquire about the specific level of care definition.

 

Thanks for all the patience.

 

Regards!

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