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Modifiers-CPT Codes

When to use a Modifier

QuestionAnswer
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