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.

If you use modifier 59 on a claim and it is denied due to bundling, you should appeal the claim with medical records. See “How do I file an appeal with Ambetter?” below.