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I apologize in advance to ruining your day…
Due to the latest billing conference, I have completed an audit on our Superbill. Upon doing so, I asked what the EP modifier was for exactly – and was informed by Medicaid (Jackie) that we have been using it wrong.
EP modifier is not for any service to a participant under 21/19 whatever you are calling it – it is for participants of the HCY (Health Children & Youth program) aka EPSDT (Early and Periodic Screening, Diagnosis, and Treatment program). These programs require the biller to complete a very detailed 10 step program done by a “qualified health care professional”. It is basically what children do at their primary care physicians office as a “physical”. It involves hearing/vision/dental/gross motor skills/ etc. It is not something that is performed at a health department without a NP or higher on staff to complete.
For a 99211 the difference in an EP modifier and not – is not very significant, but using other higher office visit codes makes a big difference.
We have chosen to correct our superbill to remove the modifier EP.
This is good to know! So they are paying for 99211 without a modifier? We will change to “no modifier” also! Thanks so much for letting us know and for finding out the answers.
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