HCPCS
Level I (CPT) Modifiers:
Modifier - as the name implies these are the two
digit code that modifies a service / procedure or an item under certain
circumstances. Modifiers may add information or change the description
according to the physician documentation to give more specificity for the
service or procedure rendered. Appending of an appropriate modifier will
effectively respond to reimbursement.
Level I Modifiers: Normally known as CPT Modifiers and consists of two numeric digits and are updated annually by AMA - American Medical Association.
The above levels of Modifiers are recognized nationally.
Modifier -21 Prolonged Evaluation and Management Services (Deleted, please use CPT 99354 to 99359)
Modifier -22 Unusual Procedural Services
Modifier -23 Unusual Anesthesia
Modifier -24 Unrelated Evaluation and Management Service by the Same Physician during a Postoperative Period
Modifier -25 Significant, Separately Identifiable Evaluation and Management Service by the Same Physician on the Same Day of the Procedure or Other Service
Modifier -26 Professional Component
Modifier -27 Multiple Outpatient Hospital E/M Encounters on the Same Date.
Modifier -29 Global procedures, those procedures where one provider is responsible for both the professional and technical component. This modifier has been deleted. If a provider is billing for a global service, no modifier is necessary.
Modifier -32 Mandated Services
Modifier -33 Preventive Service
Modifier -47 Anesthesia by Surgeon
Modifier -50 Bilateral Procedure
Modifier -51 Multiple Procedures
Modifier -52 Reduced Services
Modifier -53 Discontinued Procedure
Modifier -54 Surgical Care Only
Modifier -55 Postoperative Management Only
Modifier -56 Preoperative Management Only
Modifier -57 Decision for Surgery
Modifier -58 Staged or Related Procedure or Service by the Same Physician During the Postoperative Period
Modifier -59 Distinct Procedural Service
Modifier -62 Two Surgeons
Modifier -63 Procedure Performed on Infants less than 4kg
Modifier -66 Surgical Team
Modifier -73 Discontinued Outpatient Hospital/Ambulatory Surgery Center (ASC) Procedure prior to the Administration of Anesthesia
Modifier -74 Discontinued Outpatient Hospital/Ambulatory Surgery Center (ASC) Procedure after Administration of Anesthesia
Modifier -76 Repeat Procedure by Same Physician
Modifier -77 Repeat Procedure by Another Physician
Modifier -78 Return to the Operating Room for a Related Procedure During the Postoperative Period
Modifier -79 Unrelated Procedure or Service by the Same Physician During the Postoperative Period
Modifier -80 Assistant Surgeon
Modifier -81 Minimum Assistant Surgeon
Modifier -82 Assistant Surgeon (when qualified resident surgeon not available)
Modifier -90 Reference (Outside) Laboratory
Modifier -91 Repeat Clinical Diagnostic Laboratory Test
Modifier -92 Alternative Laboratory Platform Testing
Modifier -99 Multiple Modifiers
Level I Modifiers: Normally known as CPT Modifiers and consists of two numeric digits and are updated annually by AMA - American Medical Association.
The above levels of Modifiers are recognized nationally.
Modifier -21 Prolonged Evaluation and Management Services (Deleted, please use CPT 99354 to 99359)
Modifier -22 Unusual Procedural Services
Modifier -23 Unusual Anesthesia
Modifier -24 Unrelated Evaluation and Management Service by the Same Physician during a Postoperative Period
Modifier -25 Significant, Separately Identifiable Evaluation and Management Service by the Same Physician on the Same Day of the Procedure or Other Service
Modifier -26 Professional Component
Modifier -27 Multiple Outpatient Hospital E/M Encounters on the Same Date.
Modifier -29 Global procedures, those procedures where one provider is responsible for both the professional and technical component. This modifier has been deleted. If a provider is billing for a global service, no modifier is necessary.
Modifier -32 Mandated Services
Modifier -33 Preventive Service
Modifier -47 Anesthesia by Surgeon
Modifier -50 Bilateral Procedure
Modifier -51 Multiple Procedures
Modifier -52 Reduced Services
Modifier -53 Discontinued Procedure
Modifier -54 Surgical Care Only
Modifier -55 Postoperative Management Only
Modifier -56 Preoperative Management Only
Modifier -57 Decision for Surgery
Modifier -58 Staged or Related Procedure or Service by the Same Physician During the Postoperative Period
Modifier -59 Distinct Procedural Service
Modifier -62 Two Surgeons
Modifier -63 Procedure Performed on Infants less than 4kg
Modifier -66 Surgical Team
Modifier -73 Discontinued Outpatient Hospital/Ambulatory Surgery Center (ASC) Procedure prior to the Administration of Anesthesia
Modifier -74 Discontinued Outpatient Hospital/Ambulatory Surgery Center (ASC) Procedure after Administration of Anesthesia
Modifier -76 Repeat Procedure by Same Physician
Modifier -77 Repeat Procedure by Another Physician
Modifier -78 Return to the Operating Room for a Related Procedure During the Postoperative Period
Modifier -79 Unrelated Procedure or Service by the Same Physician During the Postoperative Period
Modifier -80 Assistant Surgeon
Modifier -81 Minimum Assistant Surgeon
Modifier -82 Assistant Surgeon (when qualified resident surgeon not available)
Modifier -90 Reference (Outside) Laboratory
Modifier -91 Repeat Clinical Diagnostic Laboratory Test
Modifier -92 Alternative Laboratory Platform Testing
Modifier -99 Multiple Modifiers
Please
note: It is also necessary
to check the respective insurance guidelines for appropriate usage of Modifiers
to avoid denials.
