Common Billing Error on Sterilization Claims – Missing FP Modifier

NCTracks has observed high numbers of claim denials for sterilizations, because providers are not using the correct modifier. Note the following state policy guidance regarding modifiers on sterilization claims:

NC Division of Medical Assistance Medicaid and Health Choice

Sterilization Procedures Clinical Coverage Policy No: 1E-3

Amended Date: July 1, 2013

Modifiers

Provider(s) shall follow applicable modifier guidelines.

All providers, except ambulatory surgical centers, must append modifier FP to the procedure code when billing for sterilization procedures. Other modifiers must be used, as applicable.

 

 

NC Division of Medical Assistance Medicaid and Health Choice

Anesthesia Services Clinical Coverage Policy No.: 1L-1

Revised Date: March 1, 2012

Billing Anesthesia for Labor, Delivery, and/or Sterilization Procedures

The following guidelines apply to billing anesthesia services for sterilization procedures:

a. CPT anesthesia procedure codes used for a sterilization procedure must be billed with ICD-9-CM diagnosis code V25.2 and modifier FP appended to the code.

b. The CPT anesthesia procedure codes that may be used for sterilization are 00840, 00851, and 00921.

c. Anesthesia reimbursement for a sterilization procedure is cut back to a flat fee when billed in conjunction with labor and delivery.