“Q0” (Zero) Modifier Replaces “QR” Modifier for Outpatient and Physician Claims | Q0 (Zero) Modifier Update
February 22: The Society submitted a letter to CMS raising concerns about the "Q0" Modifier implementation. The “QR” Modifier was deleted on January 1 while the “Q0” Modifier has an implementation date of April 7. The gap in time is intended to allow CMS contractors to upgrade their computer systems; however, claims for reimbursement are being denied. HRS also noted that CMS is requesting information that is unavailable. Read the letter (PDF, 116K) from President Bruce D. Lindsay, MD, FHRS, urging CMS to provide immediate attention to this matter. March 5: CMS responded in a letter (PDF, 35K) indicating that the “Q0” (zero) modifier does not require an FDA Investigational Device Exemption (IDE) Number. CMS completed their systems audit of CMS contractors to confirm that claims appended with the “Q0” (zero) modifier will be accepted and processed. |
Successfully reporting data for primary prevention ICD implants is a mandatory requirement of Medicare coverage. In order to obtain reimbursement, Medicare national coverage policy requires that providers implanting ICDs for primary prevention clinical indications (i.e., patients without a history of cardiac arrest or spontaneous arrhythmia) report data on each primary prevention ICD procedure.
For CY 2006-2007, the “QR” modifier was routinely added to the modifier section for outpatient and physician claims for Medicare primary prevention patients. Inpatient claims have no place on the form for adding any modifier, since modifiers cannot be appended to ICD-9 procedure codes (i.e., modifiers are only appended to HCPCS codes).
The Centers for Medicare & Medicaid Services (CMS) announced in Transmittal 1403 (PDF, 736K) and Transmittal 1418 (PDF, 208K) that effective January 1, 2008, the “QR” modifier has been deleted and replaced with a new “Q0” (zero) modifier. The “Q0” modifier must be applied to claims with date of service on or after January 1, 2008:
- Physician practices must enter “Q0” in the modifier section of the Medicare claim form for CPT code 33249 (full system implant) or 33240 (replacement generator).
- Hospitals must enter the “Q0” in the modifier section of the Medicare claim form for CPT Codes 33249 (full system implant) and CPT code 33240 (replacement).
The “Q0” modifier should be used in the same way that the “QR” modifier was previously used.
Contact Joel Harder, Director Quality Improvement and Outcomes, at jharder@HRSonline.org or (202) 464-3489 with any questions.
