When to Use Retired Modifiers in Medical Billing - dummies

When to Use Retired Modifiers in Medical Billing

Because certain payers use older claims processing systems in medical billing, you may encounter retired modifiers. Many of the Medicaid payers and some of the smaller Workers’ Compensation payers still use these older programs and, as a result, still require the use of these retired modifiers. Retired modifiers are those that were removed from the Medicare list.

One retired modifier that is still routinely used is the SG modifier, mentioned earlier. This modifier was used to indicate that the procedure code on the claim was being submitted by an ambulatory surgery center (ASC) to represent that share of the service provided.

You’re responsible for knowing which modifiers the payer requires. If you submit a claim without the appropriate modifier or with a new modifier that isn’t programmed into the payer’s processing software, the claim will reject.

To prevent this from happening and to get the claim paid faster, always check with the payer prior to submission. If the payer is one of those who doesn’t answer the phone or hasn’t updated its website with current policies, you need to follow up with a letter. In the letter, request a summary of claim filing requirements.