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5.2.5 Modifier Requirements for TOS Assignment
Modifiers for TOS assignment are not required for Texas Health Steps (THSteps) Dental claims (claim type 021), Inpatient Hospital claims (claim type 040), or Medicare Crossover claims (claim types 030, 031, 050). Additionally, procedures submitted by specific provider types such as genetics, eyeglass, THSteps medical, and birthing centers are assigned the appropriate TOS based on the provider type and/or specific procedure code, and will not require modifiers.
Most procedure codes do not require a modifier for TOS assignment, but modifiers are required for some services submitted on professional claims (claim type 020) and outpatient hospital claims (claim type 023). Services that require a modifier for TOS assignment are listed below.
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