Modifiers used in the RO Model

RO Model M-Code Modifiers

The M-Code which matches the appropriate cancer type is billed once at the start of treatment and then again at the end of treatment.  The billing is differentiated by a modifier to signify the start or end of an episode.

V1 The V1 modifier is used with the appropriate M-Code to signify the start of episode.

V2 The V2 modifier is used with the appropriate M-Code to signify the end of an episode.

Episode payments are made in two installments

1. 1. 50% at the start of the episode
   2. 50% at the end of the episode (no sooner than day 28 of the episode)

 

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Exception Modifiers

When Fee-for-Service (FFS) codes are billed by a practice that qualifies for RO Model, they must be billed with Exception modifiers.

GB Modifier The exception modifier to be used by physician group practice or freestanding radiation therapy center.

B1 Condition Code The exception modifier to be used for institutional billing.