HCPCS Modifier QJ
Published 07/16/2020
Description
Services/items provided to a prisoner or patient in state or local custody. However the state or local government, as applicable, meets the requirements in 42 CFR 411.4(b)
Guidelines and Instructions
- This modifier indicates that the physician or supplier has been instructed by the state or local government agency that requested health care items or services provided to the patient that state or local law makes the prisoner or patient responsible to repay the cost of medical services and that it pursues collection of debts incurred for furnishing such items or services with the same vigor and in the same manner as any other debt
- Medicare's policy is to deny payment for items and services furnished to beneficiaries in state or local government custody
- Submit this modifier with services that are rendered to a prisoner or a patient in a jurisdiction that meets the conditions of 42 CFR 411.4(b). These regulations state that payment may be made for services furnished to individuals or groups of individuals who are in the custody of the police or other penal authorities or in the custody of a government agency under a penal statute only if the following conditions are met:
- State or local law requires those individuals or groups of individuals to repay the cost of medical services they receive while in custody
- The state or local government entity enforces the requirement to pay by billing all such individuals, whether covered by Medicare or any other health insurance, and by pursuing the collection of the amounts they owe in the same way and with the same vigor that it pursues the collection of other debts
- CMS Pub. 100-04, chapter 1, section 10.4 (PDF, 1.63 MB)