tci Outpatient Facility Coding Alert - 2019 Issue Q3

Reader Question: Use This Modifier for Transgender Screening Mammograms

Question: How do I code for a transgender patient receiving a screening mammogram? We have a patient listed as female on our medical records, but there’s a discrepancy with the insurance company, which lists the patient as male. The claim was denied due to gender mismatch. Oklahoma Subscriber Answer: The Centers for Medicare and Medicaid Services (CMS) cleared this up in MLN Matters® Number: MM6638. Specifically, CMS states that this MLN Matters article is “based on Change Request (CR) 6638 which provides instructions for completing Part A and Part B claims for gender specific services for beneficiaries...

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