Modifier QQ Fact Sheet
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General Inquiries:
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Claim Status/Patient Eligibility:
(866) 234-7331
24 hours a day, 7 days a week
Claim Corrections:
(866) 580-5980
8:00 am to 5:30 pm ET M-Th
DDE Navigation & Password Reset: (866) 580-5986
8:00 am to 5:30 pm ET M-F
DDE System Access: (866) 518-3295
8:00 am to 5:30 pm ET M-F
EDI: (866) 234-7331
8:00 am to 5:00 pm ET M-F
General Inquiries:
(866) 234-7331
8:00 am to 5:00 pm ET M-F
Claim Status/Patient Eligibility:
(866) 518-3285
24 hours a day, 7 days a week
Claim Corrections/Reopenings:
(866) 518-3285
7:00 am to 5:00 pm CT M-F
EDI: (866) 518-3285
7:00am to 5:00 pm CT M-F
General Inquiries:
(866) 518-3285
7:00 am to 5:00 pm CT M-F
Claim Status/Patient Eligibility:
(866) 234-7331
24 hours a day, 7 days a week
Claim Corrections/Reopenings:
(866) 234-7331
8:00 am to 5:00 pm ET M-F
EDI: (866) 234-7331
8:00 am to 5:00 pm ET M-F
General Inquiries:
(866) 234-7331
8:00 am to 5:00 pm ET M-F
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General questions about Medical Review
- (866) 518-3285
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- (866) 234-7331
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- (866) 518-3285
7:00 am to 5:00 pm CT M-F
- (866) 234-7331
8:00 am to 5:00 pm ET M-F
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Contact Us About Overpayments
Inquiries regarding refunds to Medicare - MSP Related
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Secondary.Payer.Inquiry@wpsic.com
Inquiries regarding overpayments NOT associated with MSP
(866) 518-3285
7:00 am to 5:00 pm CT (8:00 am to 5:00 pm ET) M-Fri
Reimbursement.Overpayment.
Inquiry@wpsic.com
Inquiries regarding refunds to Medicare - MSP Related
(866) 234-7331
7:00 am to 5:00 pm CT (8:00 am to 5:00 pm ET) M-Fri
Secondary.Payer.Inquiry@wpsic.com
Inquiries regarding overpayments NOT associated with MSP
(866) 234-7331
7:00 am to 5:00 pm CT (8:00 am to 5:00 pm ET) M-Fri
Reimbursement.Overpayment.
Inquiry@wpsic.com
Questions regarding overpayments associated with MSP related debt
(866) 518-3285
7:00 am to 5:00 pm CT (8:00 am to 5:00 pm ET) M-Fri
Secondary.Payer.Inquiry@wpsic.com
Questions regarding overpayments NOT associated with MSP related debt
(866) 518-3285
7:00 am to 5:00 pm CT (8:00 am to 6:00pm ET) M-Fri
Payment.Recovery.Inquiry@wpsic.com
Questions regarding overpayments associated with MSP related debt
(866) 234-7331
7:00 am to 5:00 pm CT (8:00 am to 5:00 pm ET) M-Fri
Secondary.Payer.Inquiry@wpsic.com
Questions regarding overpayments NOT associated with MSP related debt
(866) 234-7331
8:00 am to 5:00 pm ET (7:00 am to 4:00pm CT) M-Fri
Payment.Recovery.Inquiry@wpsic.com
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Contact us about Appeals
7:00 am to 5:00 pm CT M-F
8:00 am to 5:00 pm ET M-F
7:00 am to 5:00 pm CT M-F
8:00 am to 5:00 pm ET M-F
Need help?
Contact Us About Provider Enrollment
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7:00 AM - 5:00 PM CT, Monday - Friday
USPS Mailing Address
WPS GHA
Medicare Provider Enrollment
P.O. Box 8248
Madison, WI 53708-8248
Overnight Delivery
WPS GHA
Medicare Provider Enrollment
1717 W. Broadway
Madison, WI 53713-1834
(866) 234-7331
8:00 AM - 5:00 PM ET, Monday - Friday
USPS Mailing Address
WPS GHA
Medicare Provider Enrollment
P.O. Box 8248
Madison, WI 53708-8248
Overnight Delivery
WPS GHA
Medicare Provider Enrollment
1717 W. Broadway
Madison, WI 53713-1834
(866) 518-3285
7:00 AM - 5:00 PM CT, Monday - Friday
USPS Mailing Address
WPS GHA
Medicare Provider Enrollment
P.O. Box 8248
Madison, WI 53708-8248
Overnight Delivery
WPS GHA
Medicare Provider Enrollment
1717 W. Broadway
Madison, WI 53713-1834
(866) 234-7331
8:00 AM - 5:00 PM ET, Monday - Friday
USPS Mailing Address
WPS GHA
Medicare Provider Enrollment
P.O. Box 8248
Madison, WI 53708-8248
Overnight Delivery
WPS GHA
Medicare Provider Enrollment
1717 W. Broadway
Madison, WI 53713-1834
Need help?
Contact us about Policies
- (866) 518-3285 - General questions about Policies
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- (866) 234-7331 - General questions about Policies
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- (866) 518-3285 - General questions about Policies
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LCD Reconsideration Request: Policycomments@wpsic.com
Draft LCD Comments: Policycomments@wpsic.com
IDE Submissions: IDE.mailbox@wpsic.com
RSVP for Open Meeting and CAC: LCDCAC@wpsic.com
Questions about Payments and Incentive Programs
(866) 518-3285
7:00 am to 5:00 pm CT (8:00 am to 5:00 pm ET) M-F
Contact us about Form CMS-588 Electronic Funds Transfer (EFT)
(866) 518-3285
7:00 am to 5:00 pm CT (8:00 am to 5:00 pm ET) M-F
Financial.Reporting.Inquiry@wpsic.com
Do not submit PHI/PII through email
Questions about Payments and Incentive Programs
(866) 234-7331
7:00 am to 5:00 pm CT (8:00 am to 5:00 pm ET) M-F
Contact us about Form CMS-588 Electronic Funds Transfer (EFT)
(866) 234-7331
7:00 am to 5:00 pm CT (8:00 am to 5:00 pm ET) M-F
Financial.Reporting.Inquiry@wpsic.com
Do not submit PHI/PII through email
Questions about Payments, Fee Schedules, and Incentive Programs
(866) 518-3285
7:00 am to 5:00 pm CT (8:00 am to 5:00 pm ET) M-F
Contact us about Form CMS-588 Electronic Funds Transfer (EFT)
(866) 518-3285
7:00 am to 5:00 pm CT (8:00 am to 5:00 pm ET) M-F
Financial.Reporting.Inquiry@wpsic.com
Do not submit PHI/PII through email
Questions about Payments, Fee Schedules, and Incentive Programs
(866) 234-7331
7:00 am to 5:00 pm CT (8:00 am to 5:00 pm ET) M-F
Contact us about Form CMS-588 Electronic Funds Transfer (EFT)
(866) 234-7331
7:00 am to 5:00 pm CT (8:00 am to 5:00 pm ET) M-F
Financial.Reporting.Inquiry@wpsic.com
Do not submit PHI/PII through email
Need help?
Need help?
Mail audit materials:
WPS GHA
ATTN: Audit Supervisor
P.O. Box 8696
Madison, WI 53708-8696
When using a delivery service:
WPS GHA
ATTN: Audit Supervisor
1717 W. Broadway
Madison, WI 53713-1834
Mail audit materials:
WPS GHA
ATTN: Audit Supervisor
P.O. Box 14172
Madison, WI 53708-0172
When using a delivery service:
WPS GHA
ATTN: Audit Supervisor
1717 W. Broadway
Madison, WI 53713-1834
Need help?
Try these links first.
Questions about Self-Service?
(866) 518-3285
7:00 am to 5:00 pm CT M-F
Try these links first.
Questions about Self-Service?
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7:00 am to 5:00 pm CT M-F
Try these links first.
Questions about Self-Service?
(866) 234-7331
8:00 am to 5:00 pm ET M-F
Try these links first.
Questions about Self-Service?
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8:00 am to 5:00 pm ET M-F
Modifier QQ Fact Sheet
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Description - QQ - Ordering professional consulted a qualified Clinical Decision Support Mechanism (CDSM) for this service and the related data was provided to the furnishing professional
Appropriate Use
- Used by the performing entity – either hospital, physician’s office, or ambulatory surgical center
- Used when the performing entity is aware the ordering physician has consulted a qualified CDSM
- CDSMs are the electronic portals through which practitioners access appropriate use criteria during the patient workup. The CDSM will provide the ordering professional with a determination of whether that order adheres to appropriate use criteria, does not adhere to appropriate use criteria or if there is no appropriate use criteria applicable
- Used on appropriate procedure codes
- Effective for services July 1, 2018
- The consultation with the CDSM and the use of the modifier are voluntary until program fully implemented. Expected January 1, 2020
- Used on the same line as the specified service by the rendering provider
Inappropriate Use
- Used on procedure codes other than those identified by CMS
- Used when the ordering practitioner did not consult the CDSM
Facts
- The Protecting Access to Medicare Act (PAMA) of 2014 section 218(b) established a new program to increase the rate of appropriate advanced diagnostic imaging services rendered to Medicare beneficiaries. Examples of advanced imaging services include computed tomography, positron emission tomography, nuclear medicine and magnetic resonance imaging.
- A consultation must take place for an applicable imaging service ordered by an ordering professional that would be furnished in an applicable setting and paid under an applicable payment system.
- Note the applicable setting is where the imaging service is furnished, not the setting where the imaging service is ordered.
- Applicable settings include physician offices, hospital outpatient departments (including emergency departments), ambulatory surgical centers, and any other provider-led outpatient setting determined appropriate by the Secretary of the Department of Health and Human Services (at this time, no other settings have been identified).
- Applicable payment systems include the physician fee schedule, the hospital outpatient prospective payment system and the ambulatory surgical center payment system.
- When this program is more fully implemented, (expected January 1, 2020) consultation with a qualified CDSM will be required and detailed information regarding the ordering professional’s consultation must be appended to the furnishing professional’s claim.
- This includes the National Provider Identifier (NPI) of the ordering practitioner and identifying which CDSM was consulted (There are multiple CDSMs available).
- The Centers for Medicare & Medical Services (CMS) does not have guidance at this time regarding what the claims-based reporting requirements will be in 2020.
- When fully implemented, this program will include exceptions to consulting CDSMs that include the ordering professional having a significant hardship, situations in which the patient has an emergency medical condition or an applicable imaging service ordered for an inpatient and for which payment is made under Part A.
- Ultimately, this program will result in identified outlier ordering professionals being subject to prior authorization.
Procedure Codes
Attachment A
MRI
70336, 70540, 70542, 70543, 70544, 70545, 70546, 70547, 70548, 70549, 70551, 70552, 70553, 70554, 70555, 71550, 71551, 71552, 71555, 72141, 72142, 72146, 72147, 72148, 72149, 72156, 72157, 72158, 72159, 72195, 72196, 72197, 72198, 73218, 73219, 73220, 73221, 73222, 73223, 73225, 73718, 73719, 73720, 73721, 73722, 73723, 73725, 74181, 74182, 74183, 74185, 75557, 75559, 75561, 75563, 75565, 76498
CT
70450, 70460, 70470, 70480, 70481, 70482, 70486, 70487, 70488, 70490, 70491, 70492, 70496, 70498, 71250, 71260, 71270, 71275, 72125, 72126, 72127, 72128, 72129, 72130, 72131, 72132, 72133, 72191, 72192, 72193, 72194, 73200, 73201, 73202, 73206, 73700, 73701, 73702, 73706, 74150, 74160, 74170, 74174, 74175, 74176, 74177, 74178, 74261, 74262, 74712, 74713, 75571, 75572, 75573, 75574, 75635, 76380, 76497
SPECT
76390
Nuclear Medicine
78012, 78013, 78014, 78015, 78016, 78018, 78020, 78070, 78071, 78072, 78075, 78099, 78102, 78103, 78104, 78110, 78111, 78120, 78121, 78122, 78130, 78135, 78140, 78185, 78191, 78195, 78199, 78201, 78202, 78205, 78206, 78215, 78216, 78226, 78227, 78230, 78231, 78232, 78258, 78261, 78262, 78264, 78265, 78266, 78267, 78268, 78270, 78271, 78272, 78278, 78282, 78290, 78291, 78299, 78300, 78305, 78306, 78315, 78320, 78350, 78351, 78399, 78414, 78428, 78445, 78451, 78452, 78453, 78454, 78456, 78457, 78458, 78459, 78466, 78468, 78469, 78472, 78473, 78481, 78483, 78491, 78492, 78494, 78496, 78499, 78579, 78580, 78582, 78597, 78598, 78599, 78600, 78601, 78605, 78606, 78607, 78608, 78609, 78610, 78630, 78635, 78645, 78647, 78650, 78660, 78699, 78700, 78701, 78707, 78708, 78709, 78710, 78725, 78730, 78740, 78761, 78799, 78800, 78801, 78802, 78803, 78804, 78805, 78806, 78807, 78811, 78812, 78813, 78814, 78816, 78816, 78999
global-tags: J8A,J5A,Advanced Diagnostic Imaging,J8B,J5B,Claims
Need help?
Contact Us About Claims
Claim Status/Patient Eligibility:
(866) 518-3285
24 hours a day, 7 days a week
Claim Corrections:
(866) 518-3253
7:00 am to 4:30 pm CT M-Th
DDE Navigation & Password Reset: (866) 518-3251
7:00 am to 4:30 pm CT M-F
DDE System Access: (866) 518-3295
7:00 am to 4:30 pm CT M-F
EDI: (866) 518-3285
7:00 am to 5:00 pm CT M-F
General Inquiries:
(866) 518-3285
7:00 am to 5:00 pm CT M-F
Claim Status/Patient Eligibility:
(866) 234-7331
24 hours a day, 7 days a week
Claim Corrections:
(866) 580-5980
8:00 am to 5:30 pm ET M-Th
DDE Navigation & Password Reset: (866) 580-5986
8:00 am to 5:30 pm ET M-F
DDE System Access: (866) 518-3295
8:00 am to 5:30 pm ET M-F
EDI: (866) 234-7331
8:00 am to 5:00 pm ET M-F
General Inquiries:
(866) 234-7331
8:00 am to 5:00 pm ET M-F
Claim Status/Patient Eligibility:
(866) 518-3285
24 hours a day, 7 days a week
Claim Corrections/Reopenings:
(866) 518-3285
7:00 am to 5:00 pm CT M-F
EDI: (866) 518-3285
7:00am to 5:00 pm CT M-F
General Inquiries:
(866) 518-3285
7:00 am to 5:00 pm CT M-F
Claim Status/Patient Eligibility:
(866) 234-7331
24 hours a day, 7 days a week
Claim Corrections/Reopenings:
(866) 234-7331
8:00 am to 5:00 pm ET M-F
EDI: (866) 234-7331
8:00 am to 5:00 pm ET M-F
General Inquiries:
(866) 234-7331
8:00 am to 5:00 pm ET M-F
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