Oncology & Hematology Coding Alert

Question: When am I supposed to start using the new NOPR modifiers?

Maryland Subscriber

Answer: CMS instructed local contractors to accept these modifiers no later than April 7. Check with your local contractor, though, because some may start accepting them sooner.

Background: HCPCS 2008 introduced modifiers Q0 (Investigational clinical service provided in a clinical research study) and Q1 (Routine clinical service provided in a clinical research study that is in an approved clinical research study). Note that Q0 is Q "zero."

You should use these modifiers to identify investigational and routine clinical services in a Medicare-approved clinical research study, according to CMS Transmittal R1418CP, CR 5805 (http://www.cms.hhs.gov/transmittals/downloads/R1418CP.pdf).

Once your contractor implements the change, you should use Q0 rather than QR (Item or service provided in a Medicare specified study) or QA (FDA investigational device exemption), and Q1 rather than QV (Item or service provided as routine care in a Medicare qualifying clinical trial).

You need to apply these modifiers when you report to the National Oncology PET Registry (NOPR), which allows participating providers to receive Medicare reimbursement for cancer imaging Medicare typically doesn't cover.