Modifiers affecting reimbursement
Bilateral Procedure
What is modifier 50?
Office
What is place of service code 11?
Medicare's Ambulatory Payment Classifications (APCs) are used to determine reimbursement of these services
What are outpatient hospital services?
CPT
What is Current Procedural Terminology?
% of MPFS Physician Assistants receive
What is 85%?
Multiple Procedures
What is modifier 51?
On Campus - Outpatient Hospital
What is POS code 22?
Short-term acute hospital inpatient stays are reimbursed based on this ICD-10 dependent patient classification scheme (multiplied by a base rate)
What is MS-DRG (or DRG)?
DOS
What is Date of Service?
% of MPFS received by Assistant at Surgery
What is 16%?
Two surgeons
What is modifier 62?
Ambulatory Surgery Center
What is POS code 24?
The Medicare Physician Fee Schedule (MPFS) is based on regionally adjusted RVUs multiple by this
What is the Medicare conversion factor?
DMEPOS
these each receive one half of 125% of the MPFS
What are co-surgeons?
Professional component
What is modifier 26?
Home
What is POS code 12?
For Medicare, a skilled nursing facility reimbursement is based in large part on these classifications
What are Resource Utilization Groups (RUG)?
RBRVS
What is Resource Based Relative Value Scale?
$33.2875
What is the current Medicare conversion factor? (MPFS)
Medical direction of two, three, or four concurrent anesthesia procedures
What is modifier QK?
Ambulance - Land (Ground)
What is POS code 41?
This is an example of a facility that Medicare reimburses based on cost
What is a Critical Access Hospital (CAH), a Cancer Hospital, or Children's Hospital?
COBRA
What is the Consolidated Omnibus Budget Reconciliation Act of XXXX?
Provide the year for a bonus!
$6,497.77
What is the 2024 IPPS base rate? (Inpatient Prospective Payment System)