Tenn. Comp. R. & Regs. 0800-02-17-.07 - MODIFIER CODES

(1) Modifiers shall be added to the procedure code when the service or procedure has been altered from the basic procedure described by the descriptor.

(2) Tennessee state-specific modifiers listed in 0800-02-18 may be added to the procedure code when criteria set forth in chapter 18 have been met.

(3) The use of modifiers does not imply or guarantee that a provider will receive reimbursement as billed. Reimbursement for modified services or procedures shall be based on documentation of reasonableness and necessity and shall be determined on a case-by-case basis. For more information on modifiers, see Chapter 0800-02-18.

Notes

Tenn. Comp. R. & Regs. 0800-02-17-.07

Public necessity rule filed June 5, 2005; effective through November 27, 2005. Public necessity rule filed November 16, 2005; effective through April 30, 2006. Original rule filed February 3, 2006; effective April 19, 2006. Amendment filed June 12, 2009; effective August 26, 2009. Repeal and new rules filed November 27, 2017; effective February 25, 2018. Administrative changes made to this chapter on September 10, 2019; "Tennessee Workers' Compensation Act" or "Act" references were changed to "Tennessee Workers' Compensation Law" or "Law." Amendments filed June 27, 2023; effective 9/25/2023.

Authority: T.C.A. §§ 50-6-204, 50-6-205, and 50-6-233 (Repl. 2005).