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Modifier 32

Effective October 1, 2010 providers must bill the following preventative medicine evaluation and management CPT codes with a 32 modifier (mandated service) when billing initial medical examinations (including all services performed during the initial visit) of children entering into state supervised care:

Preventative Medicine Visit E/M Codes

Comprehensive-New
Patient E/M Code
Periodic Comprehensive-
Established Patient E/M
Code
Qualifying Age Group
9938199391infant (0-12 mos)
9938299392early childhood (1-4 yrs)
9938399393late childhood (5-11 yrs)
9938499394adolescent (12-17 yrs)

It is important to note:

  • Initial medical screening examinations are self referred services for children in state supervised care.
  • Initial medical screening examinations must be provided by an EPSDT certified PCP within 5 days of entry into state supervised care.
  • All initial medical screenings must meet the Maryland Healthy Kids requirements as outlined in the Schedule of Preventative Health Care. Click here to access this schedule on the Healthy Kids website.
  • Failure to bill the preventative medicine E/M code with a 32 modifier could result in denial or delay in payment.
Information current as of: 06/29/15