How do I use modifiers when submitting claims?

Peach State Health Plan follows CMS guidelines with respect to modifiers. Providers are expected to use modifiers appropriately. The Provider Manual and Billing Manual, which is available on the Ambetter website under Provider Resources, will give additional information. It can be accessed through the following link: https://ambetter.pshpgeorgia.com/provider-resources.html.

The improper use of modifier 59 will probably result in the denial of a claim. You may need to file an appeal with medical records in order for the claim to be reconsidered. For example, do not use a modifier 59 when submitting for CPT code 98943. It is not required. Claims submitted with the modifier have been bundled by PSHP with the 98941 code and no additional benefits were allowed.