Last year we alerted you to a possible change by Medi-Cal to do away with the ZS modifier on radiology claims to indicate a global charge. Though eliminating the unique ZS modifier was a great idea DHCS also would have required that that global charges then be broken into two claim lines, PC and TC. The CSP submitted numerous comments in opposition to the two line process. DHCS recently published the final policy with an effective date of August 1, 2015. It eliminates the ZS modifier and a global charge would contain no modifier. Here is a copy of the notice;
Upcoming Changes: HIPAA Code Conversion for Local Modifier ZS
An article that published in the April 2015 Medi-Cal Update announced that the effective date for the discontinuation of local modifier ZS would be July 1, 2015. Local modifier ZS designates both the professional (26) and technical (TC) components of a split-billable procedure on a claim or Treatment Authorization Request (TAR). However, in order to allow sufficient time for providers to make the necessary changes, the effective date for this policy is now August 1, 2015.
Effective for dates of service on or after August 1, 2015, the Department of Health Care Services (DHCS) is discontinuing local modifier ZS. Modifier ZS designates both the professional (26) and technical (TC) components of a split-billable procedure on a claim or Treatment Authorization Request (TAR). When billing for both the professional and technical components, a modifier is neither required nor allowed. This change is to continue HIPAA compliance efforts and to align with the Centers for Medicare & Medicaid Services (CMS) guidelines.
Discontinuing local modifier ZS will affect claims and TARs for all split-billable procedures except for Magnetic Resonance Imaging (MRI), Magnetic Resonance Angiography (MRA) and Positron Emission Tomography (PET) procedures. See the relevant sections of the provider manual for details pertaining to the use of modifiers for MRI, MRA and PET procedures.
Note:
Effective for dates of service on or after August 1, 2015, providers who previously submitted claims or TARs for split-billable procedures using local modifier ZS are instructed to submit claims and TARs without a modifier.
Claim Completion
Except for MRI, MRA or PET procedures, providers will be instructed to use one of the following methods when submitting a claim for both the professional and technical components of split-billable procedures. See the relevant sections of the provider manual for details pertaining to the use of modifiers for MRI, MRA and PET procedures.
Physician Billing: The physician bills for both the professional and technical components and then reimburses the facility for the technical component, according to their mutual agreements.
The physician submits a CMS-1500 claim form with the procedure code on one claim line without a modifier in the Procedures, Services or Supplies/Modifier field (Box 24D).
Facility Billing: The facility bills for both the technical and professional components and then reimburses the physician for the professional component, according to their mutual agreements.
The facility submits a UB-04 claim form with the procedure code on one claim line without a modifier in the HCPCS/Rate/HIPPS Code field (Box 44).