Medical billers use modifiers a lot in their claims. These modifiers are necessary to tell the full story behind a service. Sometimes, when a patient visits a practice, it is not for a new clinical indication. Instead, it is just a continuation or follow-up of a previous visit. It is essential for payers to differentiate between new and continued services.
The TS modifier serves this exact purpose. However, despite being in use for more than two decades (introduced in 2002), many billers still make mistakes while using it.
That’s why we have created this guide on the TS modifier. We will explain everything you need to know about this modifier. So, let’s start.
TS Modifier – Description
The TS modifier is defined as:
“Follow-up service.”
TS is not like other modifiers. Most modifiers in medical billing have a strict and nationally standardized set of rules. This is not the case for TS. This modifier basically falls under the HCPCS Coverage Code C, which in short stands for “Carrier Judgment”. But what does this actually mean? Well, in simple terms, it is up to the different Medicare Administrative Contractors (MACs) and other payers to determine the rules and coverage criteria of TS.
Because of this, there is no single universal rulebook on how TS should be used. Billers use this modifier for services that have many follow-up visits, like diabetes monitoring or follow-up therapies/screenings. It tells the payers that the patient visit is not a new one; rather, it is a continuation of previous care.
Also, an important point to note here is that TS is an informational modifier, not a pricing modifier. So, it does not affect the reimbursement amount. Here is the TS modifier in a nutshell:
| ModifierDetail | TS |
|---|---|
| Full Description | Follow-up service |
| Code Set | HCPCS Level II |
| Coverage Code | C (Carrier judgment) |
| Date Added | October 1, 2002 |
| Action Effective Date | January 1, 2006 |
| Modifier Type | Informational (non-pricing) |
Appropriate Use Cases for TS Modifier
As we have already mentioned, there is no single rulebook on how this modifier should be used. However, to explain its usage, here are a couple of real-world scenarios in which the TS modifier can be used:
Diabetes Preventive Screening
Suppose that a 64-year-old female patient was diagnosed with prediabetes. Under the Medicare coverage rules for diabetes preventive screening, typically one screening is covered per year. However, if the patient is prediabetic, Medicare allows two preventive screenings per year, i.e., once every six months.
Based on these coverage rules, the pre-diabetic female patient undergoes a second screening after 6 months within the same rolling year.
In this case, the billing department can append the TS modifier to CPT code 82947 on the claim for diabetic preventive screening. It will explain to the payer that the second screening was a follow-up service to measure blood glucose levels in blood and aided in diabetes prevention.
Behavioral Health Follow-up
Let’s consider one more scenario. Suppose a patient begins outpatient psychotherapy for anxiety after an initial diagnostic evaluation. At a subsequent visit, the therapist reviews progress, reassesses symptoms, updates the treatment plan when supported by the documentation, and continues psychotherapy. The provider should report the appropriate psychotherapy code based on the service delivered and the payer’s requirements.
The TS modifier should be used only when the specific payer or Medicaid program requires it for that particular service, i.e., a non-face-to-face follow-up. Continuation of an established treatment plan alone does not justify TS.
Accurate Usage Guidelines for TS Modifier
The following are some guidelines that will help you use the TS modifier more accurately.
Confirm Payer-Specific Requirements
Before appending TS to any claim, first verify whether or not the insurance payer requires it. One MAC or state Medicaid program may require TS on a given service, while another payer may not recognize it at all.
So, simply because a visit counts as a follow-up service, never assume that TS is mandatory.
Tie the Encounter to the Original Service
What’s important is that you must always connect the follow-up service with the original treatment or service.
The progress notes should reference the original service date, the reason the patient is returning, and any change in status since the last visit.
Watch Modifier Combinations
TS can be combined with modifiers GX and GY. However, it should not be combined with modifiers EY, GA, GL, GZ, KB, QL, or TQ.
Review current payer policy before combining TS with other modifiers on the same claim line.
Final Thoughts on TS Modifier
We have reached the end of our guide here. Here’s a summary of what we discussed.
- TS modifier is used to indicate that a patient visit is a follow-up of a previous treatment.
- Different MACs have different rules and coverage criteria for it.
- When using this modifier, the patient visit must be connected to the original treatment.
- It is an informational modifier and does not affect the reimbursement amount.
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