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Modifiers-CPT Codes
When to use a Modifier
| Question | Answer |
|---|---|
| Modifier 22 | “when the service(s) provided is greater than that usually required for the listed procedure,” |
| Modifier 23 | Unusual Anesthesia |
| Modifier 24 | Unrelated evaluation and management service by the same physician during postoperative period. |
| Modifier 25 | Significant, separately identifiable E&M service by the same physician on the same day of a procedure or other service |
| Modifier 26 | it indicates that procedure being reported as professional component only. |
| Modifier 32 | Mandated Services.-You should append modifier 32 (Mandated services) to any service that the physician provides at the specific request of the patient’s insurer. |
| Modifier 47 | You should apply modifier 47 (Anesthesia by surgeon) if the surgeon administers his or her own anesthesia during a surgical procedure. |
| Modifier 50 | Bilateral Procedure |
| Modifier 51 | Muliple Procedures |
| Modifier 52 | Reduced Services-Modifier 52 Reduced Services; is used when a service / procedure was not completed in its entirety. |
| Modifier 53 | Discontinued Procedure |
| Modifier 54 | Surgical Care Only-When one physician performs a surgical procedure and another provides preoperative and/or postoperative management, surgical services |
| Modifier 55 | Postoperative Management Only-When one physician performed the postoperative management and another physician performed the surgical procedure |
| Modifier 56 | Preoperative Management Only-When one physician performed the preoperative care and evaluation and another physician performed the surgical procedure |
| Modifier 57 | Decision for Surgery-the initial decision to perform a surgical procedure, either the day before or the day of an urgent or emergent surgery |
| Modifier 58 | staged or related procedure or service by the same physician during the postoperative period |
| Modifier 59 | Distinct procedural service-is used to indicate that a procedure was distinct or independent from other services performed on the same date unless the codes are bundeled. |
| Modifier 62 | Two Surgeons-Two surgeons (each in a different specialty) are required to perform a specific procedure |
| Modifier 63 | Procedure performed on infants less than 4kgs |
| Modifier 66 | Surgical Team-If a team of surgeons (more than two surgeons of different specialties) is required to perform a specific procedure |
| Modifier 76 | Repeat procedure or service by same physician |
| Modifier 77 | Repeat procedure or service by another physician |
| Modifier 78 | Unplanned return to the operating/procedure room by the same physician following initial procedure for a related procedure during the postoperative period |
| Modifier 79 | Unrealted procedure or service by the same physician during the postoperative period |
| Modifier 80 | Assistant Surgeon |
| Modifier 81 | Minimum Assistant Surgon |
| Modifier 82 | Assistant Surgeon when qualified resident surgeon not available |
| Modifier 90 | Reference Outside Laboratory- if you are an independent lab billing for a test that you did not perform in-house |
| Modifier 91 | Repeat Clinical Diagnostic Labratory Test-should be appended to laboratory procedure(s) or service(s) to indicate a repeat test or procedure on the same day. |
| Modifier 92 | Alternative Labratory Platform Testing-this would be attached to a certain laboratory procedure you had done. --Not a standard test. |
| Modifier 99 | Muliple Modifiers |
Created by:
lorireid1980
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