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Elizabeth M. Whitehorn, Director

Provider Notice issued 02/17/04

Use of Modifiers on Paper Claim Forms

To:​ All Enrolled Providers​
Date:​ February 17, 2004​
Re:​ Use of Modifiers on Paper Claim Forms​

 

When the department implements HIPAA–compliant code sets effective April 1, 2004, CPT/HCPCS modifiers will be used as applicable with procedure codes, for both electronic and paper claims. As standard modifiers have not been used previously for department claims, providers who wish to bill paper claims must place the modifiers in the following fields:  

 

DPA 2360 claim form - Report the 2-byte modifier in the 24C modifier field.

  • DPA 1443 claim form - Report the 2-byte modifier in section 28, modifying units field.

  • DPA 2210, 2211 and 2212 claim forms - Report the 2-byte modifier immediately following the procedure code. As an example, procedure code G0154 with modifier U2 should be shown as G0154U2.

The department utilizes a claim imaging system for processing claims, and the system must be able to read the entries accurately. It is extremely important that no punctuation or spaces are included as part of the modifier entry. All modifiers must be in capital letters.

Transportation providers billing current paper (DPA 2209) and NSF electronic claims must continue to use the existing origin/destination alpha code set from Table B of the “Changes to Procedure Codes and Origin/Destination Codes” informational notice dated October 28, 2003. At the time the 837P electronic claim format is implemented, providers will use the HCPCS modifiers in Table C in place of the origin/destination codes in Table B, when billing electronic claims only. Providers billing paper claims will continue to use the origin and destination alpha code set. Providers billing NSF electronic claims must use the origin and destination alpha code “C” when “D” is the code listed on the prior approval letter. The notice may be viewed at <http://wwwqa.illinois.gov/hfs/MedicalProviders/notices/Pages/default.aspx>

Any questions regarding this notice may be directed to the Bureau of Comprehensive Health Services at 217-782-5565.

 

Anne Marie Murphy, Ph.D.

Administrator

Division of Medical Programs