2025 HCPCS code M-ST

HCPCS modifier M-ST is appended to codes for services rendered to trauma or injury patients.

Refer to payer-specific guidelines and policies for the use and reimbursement of modifier M-ST.Understand that Medicare does not cover this modifier.

The use of modifier M-ST depends on payer requirements and individual patient circumstances.This modifier should only be used if the services provided were directly related to the trauma or injury.

The medical necessity of the services must be established based on the severity of the trauma and the patient's medical condition, following all relevant guidelines and payer-specific criteria. The documentation must justify the care provided.

Physician or other qualified healthcare provider treating a trauma or injury patient.

IMPORTANT For Medicare patients requiring intensive trauma care from a hospital response team, use code G0390 instead.

In simple words: This modifier (M-ST) is added to medical bills when a doctor treats someone hurt in an accident or injury.It might help get extra payment from the insurance company, but Medicare doesn't cover it.

Modifier M-ST is used to indicate that the services or procedures performed were for a patient who has experienced trauma or injury.It's important to note that this modifier is not covered by Medicare, however other payers may allow its use for trauma-related care, potentially leading to supplemental payments for designated trauma centers or enhanced rates for providers meeting specific criteria.For intensive care provided by a hospital trauma response team to a Medicare patient, code G0390 should be used instead.

Example 1: A patient arrives at the emergency room after a motor vehicle accident with multiple injuries. The physician performs various procedures and the modifier M-ST is appended to reflect the trauma nature of the encounter., A patient is brought to a trauma center after a workplace injury.The trauma team provides stabilization and initial treatment.Modifier M-ST may be appended to the relevant codes to indicate the trauma context. This is subject to the payer's specific policies on coverage and payment., A patient sustains injuries during a sporting event. A physician provides care at the event or later at their office and appends the M-ST modifier to denote trauma care.

Detailed medical records documenting the trauma or injury, including mechanism of injury, date and time of injury, patient assessment, treatment provided, and any other relevant clinical information.Documentation should support medical necessity.

** Always confirm payer-specific guidelines and policies regarding the use of modifier M-ST.Incorrect use may result in claim denials or reduced reimbursement.

  • Payment Status: Variable; not covered by Medicare
  • Modifier TC rule: Not applicable.This modifier does not specify technical components.
  • Specialties:Emergency Medicine, Trauma Surgery, Orthopedics
  • Place of Service:Emergency Room - Hospital, Office, Inpatient Hospital, Ambulatory Surgical Center
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