Medical Services Complexity U5 Modifier with H2035

Jeremy Roelofs-Lynch 5 years ago in Billing/Electronic Modules updated 5 years ago 6

I am trying to get some information/clarity around using the U5 Modifier when billing out H2035. 

  1. Does anyone else bill using this modifier?
  2. Can anyone explain this Modifier to me? I am not having much luck on the old google machine!

Thank you

We use this with H2036 U5 is for medical services we are inpatient residential, H2035 is outpatient, do you provide medical services?

Thank you jparker for your response. We are OP but we have Medical Providers that offer certain services for clients. I was asked to see if we would qualify for using this code. I saw on on the DHS grid that it shows as an option for billing H2035. The Providers that come into our programming buildings are doing things like physicals and assisting/prescribing substance abuse/mental health medications. Not sure if any of this would qualify as a billable service on our side. Note - they do their own billing out of their own system. Do not want to "double dip" and bill/pay for things that would be out of compliance. 

Not sure what qualifies as "medical services"?

Also you can google DHS Rate Reform grid will give you all modifiers with rates

Jeremy, It is my understanding that you have a nurse or TMA on staff, I may be wrong with OP but residential you must.

You have to have availability of at least 2 hours of medical services per client per week on site in order to qualify for this modifier.  You don't have to actually provide that 2 hours per client but you have to show that you have the staff available to provide that much.  You have to have signed an assurance statement with the state that indicates what services you are providing and be able to demonstrate how you are meeting that requirement. Once you have that, everything you bill would be with the addition of the medical modifier so long as the client has that on their authorization.  It's not just for the medical services you provide but it's for you having the capacity to provide it.

This is great information -- thank you Bobbi.