CurrentNeighborhood Health Plan of Rhode IslandPolicy N/A

Non Covered Modifiers

Lists billing modifiers that Neighborhood Health Plan of Rhode Island does not cover across Medicaid, Commercial, and INTEGRITY product lines; affects providers submitting claims to these lines.

Policy Summary

PayerNeighborhood Health Plan of Rhode Island

PolicyNon Covered Modifiers

Policy CodePolicy N/A

Change TypeNo material change

Effective DateN/A

Next Review DateN/A

Key ActionProviders should avoid appending listed modifiers when billing Medicaid, Commercial, or INTEGRITY products as marked.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

~50modifier entries listed as non-covered (approximate)

3product lines referenced

somevariation across product lines

Non-Coverage Criteria by Modifier

Non-coverage criteria by modifier

Modifiers listed with an 'X' under a product line are treated as non-covered for that product line.

Modifier 21: Medicaid = X; Commercial = X; INTEGRITY = (no entry)

Modifier EY: Medicaid = X; Commercial = X; INTEGRITY = X

Modifier GC: Medicaid = X; Commercial = X; INTEGRITY = (no entry)

Modifier GL: Medicaid = X; Commercial = X; INTEGRITY = X

Modifier GY: Medicaid = (no entry); Commercial = X; INTEGRITY = X

Policy Summary

PayerNeighborhood Health Plan of Rhode Island

PolicyNon Covered Modifiers

Policy CodePolicy N/A

Change TypeNo material change

Effective DateN/A

Next Review DateN/A

Key ActionProviders should avoid appending listed modifiers when billing Medicaid, Commercial, or INTEGRITY products as marked.

SourceLink

On This Page

Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.

Modifier HU: Medicaid = X; Commercial = X; INTEGRITY = X

Modifier HV: Medicaid = X; Commercial = X; INTEGRITY = X

Modifier HW: Medicaid = X; Commercial = X; INTEGRITY = X

Modifier HX: Medicaid = X; Commercial = X; INTEGRITY = X

Modifier HY: Medicaid = X; Commercial = X; INTEGRITY = X

Modifier HZ: Medicaid = X; Commercial = X; INTEGRITY = X

Modifier J1: Medicaid = X; Commercial = X; INTEGRITY = X

Modifier J2: Medicaid = X; Commercial = X; INTEGRITY = X

Modifier J3: Medicaid = X; Commercial = X; INTEGRITY = X

Modifier MS: Medicaid = X; Commercial = X; INTEGRITY = X

Modifier P6: Medicaid = X; Commercial = X; INTEGRITY = X

Modifier Q2: Medicaid = X; Commercial = X; INTEGRITY = X

Modifier Q5: Medicaid = X; Commercial = X; INTEGRITY = X

Modifier Q6: Medicaid = X; Commercial = X; INTEGRITY = X

Modifier QJ: Medicaid = X; Commercial = X; INTEGRITY = X

Modifier QR: Medicaid = X; Commercial = X; INTEGRITY = X

Modifier SV: Medicaid = X; Commercial = X; INTEGRITY = X

Modifier TK: Medicaid = X; Commercial = X; INTEGRITY = X

Modifier TR: Medicaid = X; Commercial = X; INTEGRITY = X

Modifier ZZ: Medicaid = (no entry); Commercial = X; INTEGRITY = X

Non-Covered Modifiers and Coverage Flags

Non-covered modifiersModifierNot Covered

21	Modifier 21 shown as not covered for Medicaid and Commercial; INTEGRITY blank
EY	Modifier EY not covered for Medicaid, Commercial, INTEGRITY
GC	Modifier GC not covered for Medicaid and Commercial; INTEGRITY blank
GL	Modifier GL not covered for Medicaid, Commercial, INTEGRITY
GY	Modifier GY not covered for Commercial and INTEGRITY; Medicaid blank
HU	Modifier HU not covered for Medicaid, Commercial, INTEGRITY
HV	Modifier HV not covered for Medicaid, Commercial, INTEGRITY
HW	Modifier HW not covered for Medicaid, Commercial, INTEGRITY
HX	Modifier HX not covered for Medicaid, Commercial, INTEGRITY
HY	Modifier HY not covered for Medicaid, Commercial, INTEGRITY

1–10 of 25

1/3

Coverage flags per product line

21Medicaid = X; Commercial = X; INTEGRITY = (blank)

EYMedicaid = X; Commercial = X; INTEGRITY = X

GCMedicaid = X; Commercial = X; INTEGRITY = (blank)

GLMedicaid = X; Commercial = X; INTEGRITY = X

GYMedicaid = (blank); Commercial = X; INTEGRITY = X

Provider Billing Guidance — Actionable Notes

Billing Rule

Non‑covered modifiers — provider billing guidance

Providers must not append the following non-covered modifiers to professional claims. Appending these modifiers may result in claim denial or denial of payment; verify payer-specific billing rules before submission and remove any unsupported modifiers. If a modifier is required by another payer, document medical necessity and the reason for use in the medical record.

Affected modifiers: 21, EY, GC, GL, GY, HU, HV, HW, HX, HY, HZ, J1, J2, J3, MS, P6, Q2, Q5, Q6, QJ, QR

Coverage Marker Definitions

Coverage marker (X / blank)

Definition of 'X''X' denotes the modifier is listed as not covered for that product line.

Blank / dotA blank or dot indicates no entry or that coverage status is unspecified for that product line in this listing.

ScopeMarkers are provided for three product lines: Medicaid, Commercial, and INTEGRITY.

InterpretationModifiers marked with 'X' should not be appended when billing the corresponding product line.