I don’t know how many of my California anesthesiologist readers are contracted with Medi-Cal, but I am sure there are a few of you.
I am also sure that you know how little they pay you. But, I have recently figured out a way to get them to pay you a small amount more.
Usually, Medi-Cal will only pay for anesthesia for one service per day. It had never mattered that the anesthesia was for a different surgery at a different time on a different body part.
But in 2015 CMS started using the X (EPSU) modifiers. Applying them to the appropriate line item has allowed me to increase my provider’s reimbursement from Medi-Cal to all line items submitted on the claim. The modifiers are as follows:
- XE – “Separate encounter, A service that is distinct because it occurred during a separate encounter” This modifier should only be used to describe separate encounters on the same date of service.
- XS – “Separate Structure, A service that is distinct because it was performed on a separate organ/structure”
- XP – “Separate Practitioner, A service that is distinct because it was performed by a different practitioner”
- XU – “Unusual Non-Overlapping Service, The use of a service that is distinct because it does not overlap usual components of the main service”
Use the modifier on the line that pays less, just in case the automatic processing system decides it hates your particular claim. Also, since Medi-Cal does not accept more than one modifier per line, remember to use your 99 and indicate the modifiers in box 19.
Call or email with any questions.