Have you ever faced denial of a claim for a medical procedure that used a device the healthcare provider received for free? If yes, then most probably that denial occurred due to incorrect usage of the modifier FB.
Billing for no-cost or full-credit devices is one of the most technical areas of outpatient facility billing. That’s why we have created this detailed guide on the FB modifier. We will walk you through what this modifier is, how it is used in real claims, how it is related to other codes, and some additional guidelines. So, let’s start.
FB Modifier – Description
FB modifier is defined as:
“Item provided without cost to provider, supplier or practitioner, or full credit received for replaced device (examples, but not limited to, covered under warranty, replaced due to defect, free samples).”
FB is an HCPCS Level II modifier. Before FB existed, there was no standardized way to communicate to payers that a device used in a procedure was provided at zero cost to the facility.
An important point to note here is that modifier FB does not describe the procedure itself. Instead, it describes the cost status of the device or item used in that procedure. When the manufacturer provides an item to the healthcare provider at no cost (whether due to a warranty, a recall, a defect, or as a free sample), it is the responsibility of the healthcare provider to inform the insurance payer before filing the claim. Without FB, payers apply full payment logic to the claim, resulting in an overpayment.
Another thing worth mentioning here is that FB is closely related to the FC modifier. FC applies when a provider receives a partial credit (50% or more) of the cost of a replacement device. However, these two must never appear together on the same procedure code line. Moreover, both the FB and FC modifiers are exclusively used when ambulatory surgical centers (ASCs) file facility claims for a variety of outpatient services.
Here is a table that shows the relation of the FB modifier with FC and other condition codes:
| Modifier / Code | Description | When to Use |
|---|---|---|
| FB | Item provided without cost to provider, supplier, or practitioner, or full credit received for replaced device. | Device furnished under warranty, due to recall/defect, as a free sample, or in a clinical trial at no cost to the provider. |
| FC | Partial credit (50% or more) received for the replaced device. | Provider receives a partial credit of at least 50% for a replaced device; do not combine with FB on the same claim line. |
| Condition Code 49 | Product lifecycle replacement earlier than anticipated due to a malfunction. | Reported on institutional claims alongside modifier FB for a within-warranty device replacement. |
| Condition Code 50 | Product replacement for a known recall by the manufacturer or the FDA. | Reported on institutional claims alongside modifier FB when a device was recalled. |
| Condition Code 53 | Initial placement of a device provided in a clinical trial or as a free sample. | Used for clinical trial devices or free-sample devices on institutional claims. |
Source: Molina Healthcare
Appropriate Use Cases for FB Modifier
Let’s step away from theory and look at a couple of real-world scenarios in which the FB modifier can be used:
Recalled Cardiac Device
Suppose a patient is admitted to an ASC with a previously implanted pacemaker that the manufacturer identified as defective. The manufacturer issues a voluntary recall and provides the ASC with a replacement pacemaker at no cost. The medical team quickly schedules the surgery and implants the new device.
In this case, here is how the billing team would fill the UB-04 claim. The device HCPCS code line is billed with a charge of $0.00. The biller would then append the FB modifier to the CPT code for the device implantation. Condition code 50, which indicates a product replacement for a known recall, is also reported on the institutional claim.
Device Replacement Under Warranty
Suppose a patient has a previously implanted deep-brain stimulation (DBS) device that has stopped functioning within its expected lifecycle. The manufacturer confirms the malfunction occurred within the warranty period and provides a replacement at no cost to the ASC. The clinical team schedules the replacement procedure.
On the claim form, the billing department assigns a $0.00 charge (or $1.00 token) to the device HCPCS code line. FB modifier is then appended to the procedure code for implantation, not the device code. Condition code 49, which represents a product replacement within the expected product lifecycle due to a malfunction, is also reported on the UB-04 claim.
Accurate Usage Guidelines for FB Modifier
The following are some essential guidelines that you must follow when using modifier FB in your claims:
- Append the FB modifier to the procedure code, not the device line.
- Report the appropriate condition codes (49, 50, and 53) on institutional claims.
- FB is intended for outpatient claims only.
- Never use FB and FC on the same claim line.
- Modifier FB only triggers the device payment adjustment for specific procedures listed in the CMS ASC FB/FC device adjustment policy files. Always confirm the code is on the current list before appending FB on an ASC claim.
- Maintain thorough supporting documentation. Keep records showing:
- Manufacturer confirmation of no-cost or full-credit device.
- Reason for replacement (recall, warranty, defect, clinical trial).
- Date device was received and date of implantation.
- Procedure code billed.
Final Thoughts on FB Modifier
Let’s wrap up everything we have discussed in this guide.
- The FB modifier is an HCPCS Level II modifier. It indicates that a device was furnished to a provider at no cost.
- The modifier must be appended to the procedure code.
- It is used for outpatient claims only, typically ASC facility claims.
- The appropriate condition codes (49, 50, or 53) must also be reported on institutional claims.
Even with all the guidelines, medical billing can be tricky, and most in-house billing teams fail to achieve quality results. That’s why it is better to get professional medical billing and coding services from companies like NeuraBill. Our billing team has the experience, expertise, and tools needed to guarantee exceptional revenue collection.
