Modifiers for Single and Multiple Patients Served at the Same

90.3.4 – Modifiers for Single and Multiple Patients Served at the Same Location (Rev. 13150; Issued:04-11-2025; Effective: 01-01-2025; Implementation:05-12-2025) This component represents the transportation of the equipment to the patient. Establish local RVUs for the transportation R codes based on MAC knowledge of the nature of the service furnished. The MACs shall allow only a single transportation payment for each trip the portable x-ray supplier makes to a particular location. When more than one patient is x-rayed at the same location, e.g., a nursing home, prorate the single fee schedule transportation payment among all patients (Medicare Parts A and B, and non- Medicare) receiving the portable x-ray services during that trip, regardless of their insurance status. For example, for portable x-ray services furnished at a Skilled Nursing Facility (SNF), the transportation fee should be allocated among all patients receiving portable x-ray services at the same location in a single trip irrespective of whether the patient is in a Part A stay, a Part B patient, or not a Medicare beneficiary at all. If the patient is in a Part A SNF stay, the transportation and set up costs are subject to consolidated billing and not separately billable to Medicare Part B. For a privately insured patient, it would be the responsibility of that patient’s insurer. For a Medicare Part B patient, payment would be made under Part B for the share of the transportation fee attributable to that patient. R0075 must be billed in conjunction with the radiology codes and only when the x-ray equipment used was actually transported to the location where the x-ray was taken. R0075 would not apply to the x-ray equipment stored in the location where the x-ray was done (e.g., a nursing home) for use as needed. Below are the definitions for each modifier that must be reported with R0075. Only one of these five modifiers shall be reported with R0075. NOTE: If only one patient is served, R0070 should be reported with no modifier since the descriptor for this code reflects only one patient seen. UN - Two patients served UP - Three patients served UQ - Four patients served UR - Five Patients served US - Six or more patients served Payment for the above modifiers must be consistent with the definition of the modifiers. Therefore, for R0075 reported with modifiers, -UN, -UP, -UQ, and –UR, the total payment for the service shall be divided by 2, 3, 4, and 5 respectively. For modifier –US, the total payment for the service shall be divided by 6 regardless of the number of patients served. For example, if 8 patients were served, R0075 would be reported with modifier –US and the total payment for this service would be divided by 6. The units field for R0075 shall always be reported as “1” except in extremely unusual cases. The number in the units field should be completed in accordance with the provisions of 100-04, chapter 23, section 10.2 item 24 G which defines the units field as the number of times the patient has received the itemized service during the dates listed in the from/to field. The units field must never be used to report the number of patients served during a single trip. Specifically, the units field must reflect the number of services that the specific beneficiary received, not the number of services received by other beneficiaries. NOTE: No transportation charge is payable unless the portable x-ray equipment used was actually transported to the location where the x-ray was taken. For example, MACs do not allow a transportation charge when the x-ray equipment is stored in a nursing home for use as needed. However, a set-up payment (see §90.4, below) is payable in such situations. Further, for services furnished on or after January 1, 1997, MACs may not make separate payment under HCPCS code R0076 for the transportation of EKG equipment by portable x-ray suppliers or any other entity.