Informational Only Modifier Fact Sheet
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General Inquiries:
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Claim Status/Patient Eligibility:
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Claim Corrections/Reopenings:
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General Inquiries:
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Claim Status/Patient Eligibility:
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General Inquiries:
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Secondary.Payer.Inquiry@wpsic.com
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Inquiries regarding refunds to Medicare - MSP Related
(866) 234-7331
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Secondary.Payer.Inquiry@wpsic.com
Inquiries regarding overpayments NOT associated with MSP
(866) 234-7331
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Reimbursement.Overpayment.
Inquiry@wpsic.com
Questions regarding overpayments associated with MSP related debt
(866) 518-3285
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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
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Secondary.Payer.Inquiry@wpsic.com
Questions regarding overpayments NOT associated with MSP related debt
(866) 234-7331
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Payment.Recovery.Inquiry@wpsic.com
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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
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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
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Contact us about Form CMS-588 Electronic Funds Transfer (EFT)
(866) 518-3285
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Financial.Reporting.Inquiry@wpsic.com
Do not submit PHI/PII through email
Questions about Payments and Incentive Programs
(866) 234-7331
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Contact us about Form CMS-588 Electronic Funds Transfer (EFT)
(866) 234-7331
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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
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Questions about Self-Service?
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Try these links first.
Questions about Self-Service?
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Try these links first.
Questions about Self-Service?
(866) 234-7331
8:00 am to 5:00 pm ET M-F
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Questions about Self-Service?
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Informational Only Modifier Fact Sheet
You currently have jurisdiction selected, however this page only applies to these jurisdiction(s): .
The modifiers included below are Informational Only and should be placed after all pricing modifiers.
Modifier | Description |
---|---|
AQ | Services provided in a Health Professional Shortage Area (HPSA) |
CB | Services ordered by a dialysis facility physician as part of the ESRD beneficiary's dialysis benefit, is not part of the composite rate, and is separately reimbursable |
CR | Emergency health care needs of beneficiaries and providers affected by Hurricane Katrina and any future disasters |
GA | The provider or supplier has provided an Advance Beneficiary Notice of Noncoverage (ABN) to the patient and has a signed copy on file |
GN | Services delivered under an outpatient speech-language pathology plan of care |
GO | Services delivered under an outpatient occupational therapy plan of care |
GP | Services delivered under an outpatient physical therapy plan of care |
GV | Attending physician not employed or paid under agreement by the patient's hospice provider |
GW | Service not related to the hospice patient's terminal condition |
GY | Statutorily excluded service - If the service provided is statutorily excluded from the Medicare Program, the claim will deny whether or not the modifier is present on the claim |
GZ | The provider or supplier expects a medical necessity denial; however, did not provide an Advance Beneficiary Notice of Noncoverage (ABN) to the patient |
QW | CLIA waived test |
Q5 | Service furnished by a substitute physician under a reciprocal billing arrangement |
Q6 | Service furnished by a fee-for-time compensation arrangements physician |
22 | Increased Procedural Service requiring work substantially greater than typically required |
24 | Unrelated evaluation and management (E/M) service by the same physician* during a postoperative period |
25 | Significant, separately identifiable evaluation and management (E/M) service by the same physician* on the day of a procedure |
27 | Multiple Outpatient Hospital E/M Encounters on the Same Day (Not required by CMS and not to be used by physicians for reporting of multiple E/M services) |
52 | Reduced Service reports a partially reduced or eliminated service or procedure |
57 | Indicates an Evaluation and Management (E/M) service resulted in the initial decision to perform surgery either the day before a major surgery (90-day global) or the day of a major surgery |
58 | Indicates a staged or related procedure or service by the same physician* during the postoperative period |
59 | Distinct Procedural Service identifies procedures/services not normally reported together, but appropriately billable under the circumstances |
63 | Procedure Performed on Infants less than 4 kg |
66 | If a team of surgeons (more than two surgeons of different specialties) is required to perform a specific procedure, each surgeon bills for the procedure with a modifier "-66" |
74 | Discontinued Out-Patient Hospital/Ambulatory Surgery Center (ASC) Procedure after administration of anesthesia |
76 | Repeat Procedure by the *Same Physician; use when it is necessary to report repeat procedures performed on the same day |
77 | Repeat Procedure by another physician |
79 | Unrelated procedure by the same physician during the postoperative period |
90 | Reference (Outside) Laboratory |
99 | Multiple Modifiers are required on one line of service |
*Same physician - Medicare regulation states: "Physicians in the same group practice who are in the same specialty must bill and be paid as though they were a single physician." The same physician concept also applies when the exact same physician performs services.
global-tags: J8A,J5A,J8B,J5B
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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
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