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Minnesota-defined U Modifiers

Revised: 10-21-2016

CMS developed 13 U modifiers for state definition. The definition depends on the procedure code and modifier combination. . Use this list to identify services using the U modifiers. Refer to specific manual sections to identify when other modifiers may also be needed.

Modifiers
(Use with codes and additional modifiers in Codes column.)

Service

Codes
(Use the codes and modifiers indicated in this column in addition to the designated U modifier from the left column.)







U1

Autism spectrum disorder screening in toddlers

96110

Consumer Directed Community Supports (CDCS) – personal assistance

T2028

Dialectical behavior therapy (DBT)

H2019

Health Care Home (Medical Home Program) – comprehensive care coordination and planning, initial plan; Tier 1

  • • If necessary, add U3 – if primary language is not English
  • • If necessary, add U4 – if severe and persistent mental illness
  • S0280 – 1st month


    Health Care Home (Medical Home Program) – comprehensive care coordination and planning, maintenance of plan; Tier 1

  • • If necessary, add U3 – if primary language is not English
  • • If necessary, add U4 – if severe and persistent mental illness
  • S0281 – each additional month

    Individualized Education Program (IEP) physical therapy – evaluation

    T1018

    Individualized Education Program (IEP) physical therapy – services

    T1018+TM

    Substance abuse treatment–special population and clients with children substance abuse treatment–outpatient nonresidential

    H2035
    H2035+U4+U6

    Community Transitional services – furniture

    T2038

    Vulnerable adult case management

    T2023
















    U2

    Nonemergency Medical Transportation , Unassisted Transportation Mileage

    S0215

    Care coordination, extended complexity level, Health Care Homes (Medical Home)

    S0280–S0281

    Consumer Directed Community Supports (CDCS) treatment and training

    T2028

    Health Care Home (Medical Home Program) comprehensive care coordination and planning, initial plan; Tier 3

  • • If necessary, add U3 – if primary language is not english
  • • If necessary, add U4 – if severe and persistent mental illness
  • S0280 – 1st month

    Health Care Home (Medical Home Program) – comprehensive care coordination and planning, maintenance of plan; Tier 3

  • • If necessary, add U3 – if primary language is not english
  • • If necessary, add U4 – if severe and persistent mental illness
  • S0281 – each additional month

    Home care case management

    HCPCS

    Individualized Education Program (IEP) occupational therapy – evaluation

    T1018

    Individualized Education Program (IEP) occupational therapy – services

    T1018+TM

    In-reach community-based service coordination

    T1016

    Post-injury neurocognitive testing

    96120

    Substance abuse treatment – child or adolescent and integrated mental health and substance abuse

    H0020, H0047, H2035 (+HA+HH)

    Transitional services – supplies; community transition – waiver

    T2038











    U3

    Approved assessment penalty reconsideration

    T1001

    Basic living and social skills; Transition to Community Living

    H2017

    Basic living and social skills; Transition to Community Living by a mental health rehabilitation worker

    H2017 + HM

    Child Welfare Targeted Case Management (CW-TCM)

    T1017, T2023

    Consumer Directed Community Supports (CDCS) – environmental modifications and provisions

    T2028

    Enhanced service or item for sign language or any DMEPOS, etc.)

    T1013, eligible DMEPOS codes

    Home and Community-based Supports:
    -Supported housing, per diem – H0043
    -Skills training and development, via phone – H2014
    -Skills training and development – H2014 U4
    -Skills training and development, Individualized service provided to more than one patient in the same setting – H2014 TT


    H0043
    H2014
    H2014 +U4

    H2014 TT

    Individualized Education Program (IEP) – speech therapy – evaluation

    T1018

    Individualized Education Program (IEP) – speech therapy – services

    T1018+TM

    Health Care Home (Medical Home Program), complicating factor –non-English language

    S0280 – 1st month
    S0281 – each additional month

    Service provided by emergency medical technician–community paramedic (EMT-PC)

    T1016

    Substance abuse treatment – Integrated Mental Health and special population

    H2035, H0020, H0047: (+U4+HH)







    U4

    Doula service

    99199, S9445

    Consumer Directed Community Supports (CDCS) – self-direction support activities

    T2028

    Individualized Education Program (IEP) mental health – evaluation

    T1018

    Individualized Education Program (IEP) mental health – services

    T1018+HE+-

    Health Care Home (Medical Home Program), complicating factor, major mental health condition

    S0280 – 1st month
    S0281 – each additional month

    Overnight study – oximeter

    E0445

    Service provided via non face-to-face contact, for example, telephone

    99499, (T1013), (T1017+U3), (T2023+U1)

    Substance abuse treatment – special population

    H0020, H2035, H2036


    U5

    End tidal CO2 monitor, monthly rental

    E1399

    Certified peer specialist – advanced level

    H0038

    Individualized Education Program (IEP) nursing services – evaluation

    T1018

    Individualized Education Program (IEP) nursing – services

    T1018+TM

    Behavioral Health Home – comprehensive care coordination and planning, initial plan

    S0280

    Behavioral Health Home – comprehensive care coordination and planning, maintenance of plan

    S0281

    Partial day – Day Training and Habilitation (DT&H)

    T2018, T2020

    Service units available through the notice of termination, reduction or denial of services(MAT) – Personal Care

    T1019

    Substance abuse treatment - with medical services

    H0020, H2035, H2036


    U6

    Individualized Education Program (IEP) personal care assistance (PCA)

    T1018+TM

    End tidal CO2 spot check, weekly rental

    E1399

    Interactive – behavioral health day treatment

    H2012

    Moving Home Minnesota (MHM) – demonstration project

    A0160, A0170, A0180, A0190, A0200, A0210, H0038, H0045, H2000, H2027, S5115, S5135, S5150, S5151, S5161, S5162, S5165, (S9970+U5), T1016, (T1017+UD) T1999, T2013, T2015, T2019, T2029, (T2038+U1), (T2038+U2). (T2038+UA)

    Substance abuse treatment – parents with children

    H2035, H2036

    Temporary service license, nursing assessment or evaluation

    T1001

    Temporary service license, RN services, up to 15 minutes

    T1019


    U7

    Indivdualized Education Program (IEP) assistive technology device

    T1018 +TM

    Adult Day Care – Essential Community Support (ECS)

    S5100

    Nonemergency medical transportation (NEMT) – bus or train, monthly pass

    A0110

    Oximeter for intermittent use

    E0445

    Physician extender (medical services)

    HCPCS


    U8

    Psychiatric consult to primary care, 5–10 minutes unlisted evaluation and management service

    99499

    Consumer Directed Community Supports (CDCS) flexible case management – separately recognized component of self-direction support activities

    T2028

    Indivdualized Education Program (IEP) special transportation

    T1018 +TM

    Mental health clinical care consult, 5–10 minutes unlisted psychiatric service or procedure

    90899

    Nonemergency medical transportation (NEMT) – level-of-need (LON) assessment

    T1023

    Substance abuse treatment - with medication assisted therapy (MAT) dosing

    H2035, H2036


    U9

    Psychiatric consult to primary care, 11–20 minutes, unlisted evaluation and management service

    99499

    Behavioral programming by aide

    S5135

    Corporate settings

    S5140, S5141, T2017, T2016, T2030(+TG), T2032

    Housing Access Services (HAS); person-centered planning

    H2015

    Mental health cinical care consult, 11–20 minutes, unlisted mental health psychiatric service or procedure

    90899

    Nonemergency medical transportation (NEMT) level-of-need assessment II (LON II)

    T1023

    Teledentistry – limited services, for children and pregnant women

    Minnesota Statutes 256B.0625, subdv. 9

    Claim modifiers and system changes are not yet complete. See previous Provider News announcement.

    Substance abuse medication assisted therapy – all other MAT drugs

    H0047






    UA

    Children’s Therapeutic Services and Supports (CTSS)

    All eligible CTSS codes. (See the CTSS section of the Provider Manual for all procedure code and modifier combinations)

    Item, service, or procedure furnished in conjunction with a demonstration project

    E1399, S9441, T1028, T2038

    Night supervision – Companion Care Services; per 15 minutes

    S5135

    Night supervision – Companion Care Services; per diem

    S5136

    Nonemergency Medical Transportation (NEMT), protected transport base rate

    T2003

    Nonemergency Medical Transportation (NEMT), protected transport mileage

    S0215

    Personal care assistant – (PCA) supervision

    T1019

    Nonemergency Medical Transportation (NEMT); mileage, per mile, protected transport

    S0215

    Nonemergency Medical Transportation (NEMT); encounter or trip, protected transport

    T2003

    Substance abuse medication assisted therapy – Methadone Plus

    H0020











    UB

    Psychiatric consult to primary care, 21–30 minutes unlisted evaluation and management service

    99499

    Companion Care Services, 24-hour emergency service; per 15 minutes

    S5135

    Companion Care Services, 24-hour emergency service; per diem

    S5136

    Day Training and Habilitation (DT&H) pilot Rate C

    T2021

    Early Intensive Developmental and Behavioral Intervention (EIDBI) services

    0359T, 0362T, 0363T, 0364T, 0365T, 0366T, 0367T, 0368T, 0369T, H0032, H0046, T1024, T1027 (see the EIDBI section of the Provider Manual for more modifier combinations)

    Housing Access Services (HAS) stage 1 [non PMAP]

    H2015

    Mental health clinical care consult, 21–30 minutes unlisted psychiatric service or procedure

    90899

    Nonreservation American Indian chemical health only

    (HCPCS)+UB

    Out-of-home respite

    S5150

    Substance abuse medication assisted therapy – all other MAT drugs Plus

    H0047








    UC

    Psychiatric consult to primary care, 31 or more minutes, unlisted evaluation and management service

    99499

    Child and Teen Checkup (C&TC) maternal depression screening

    99420

    Extended home care services

    S5181, S9128, S9129, S9131 T1002, T1003, T1019

    Housing Access Services (HAS) stage 2 [non PMAP]

    H2015

    Mental health clinical care consult, 31 or more minutes, unlisted psychiatric service or procedure

    90899

    Nonemergency medical transportation (NEMT) mileage provided by licensed foster parent

    A0090

    Specialized maintenance therapy

    HCPCS

    Substance abuse treatment - combination co-occurring mental health, medical services

    H0020, H2035, H2036 (U5+HH)

    Waiver case management

    T1016






    UD

    Mental health assessment by nonphysician, follow up or review (ARMHS)

    H0031+TS

    Mental health assessment by nonphysician (ARMHS)

    H0031

    Mental health service plan development by nonphysician (ARMHS)

    H0032

    Mental health service plan development by nonphysician, follow up or review (ARMHS)

    H0032+TS

    Assessment of Environmental Accessibility adaptations for vehicle modifications (waiver)

    T2039

    Deficit Reduction Act (DRA) reporting exception, 340B purchased drug – HCPCS subset requiring National Drug Code (NDC)

    HCPCS

    Emergency department (ED) triage; typically 10 minutes

    99201

    Emergency department (ED) triage; typically 5 minutes

    99211

    Family support grant

    T2025

    Housing Access Services (HAS); Stage 3, (non PMAP)

    H2015

    Personal care assistant (PCA) provider with no familial relationship to recipient

    T1019

    Professional service for fitting and evaluation of customized durable medical equipment (DME) and prosthetics or orthotics (PO)

    K0108

    Substance abuse treatment – low intensity

    H2036

    Transitioning to community living services; environmental intervention for management of medical conditions – 1 session

    90882

    Transitioning to community living services; psychosocial rehabilitation services, per 15 minutes

    H2017

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