Wiki Cigna Medicare- modifiers

[sbarrila]

We bill for an Ambulatory Surgery Center and we are being told by Cigna Medicare that we need to add a TC modifier to our claims. They do not accept the SG modifier but they claim that we have to add the TC. Has anyone else had any issues with this? Thanks.

 

[RebeccaWoodward*]

Surgical services billed with the ASC facility service modifier SG must be reported as TOS F. The indicator F does not appear on the TOS table because its use is dependent upon the use of the SG modifier. Effective for services on or after January 1, 2008, the SG modifier is no longer applicable for Medicare services. ASC providers should discontinue applying the SG modifier on ASC
facility claims.

https://www.cms.gov/transmittals/downloads/R1410CP.pdf

The #1 FAQ
Question: For 2008, should ASCs continue to bill the -SG modifier?

Answer: No. For dates of service January 1, 2008, and after, ASCs no longer are required to include the -SG modifier on claims to Medicare. (The Medicare system will identify it as an ASC facility claim from the specialty code “49” on the provider file for the reported PTAN/NPI.

http://www.cignagovernmentservices.com/partb/education/pdf/ASC_2008.pdf

Does the service have a technical and professionl component?

 

[sbarrila]

I am aware that Medicare does not require the SG modifier any longer. I just didnt know what the Medicare replacement plans policies ( If any) were. We bill several other Medicare plans and do not have this issue. The service we are billing for are colonoscopy/egd. We bill for the Facility and the practice bills for the services of the Surgeon ( GI Doc) Thanks,

 

[JMeggett]

We bill for an Ambulatory Surgery Center and we are being told by Cigna Medicare that we need to add a TC modifier to our claims. They do not accept the SG modifier but they claim that we have to add the TC. Has anyone else had any issues with this? Thanks.

We bill Cigna Medicare for our Ortho ASC claims and haven't been told this one yet. The -TC modifier is for the technical component of radiology codes & fluoroscopic guidance codes, is that what they're referring you to add -TC to? If they're asking you to add -TC to surgical procedural codes then contact your Provider Rep at Cigna because that wouldn't be correct. Good luck!

Jenna