Question 1

INCREASED PROCEDURAL SERVICES: 
Indicates services significantly greater
than usual
• Accompanied by written report with
supportive documentation
• Describes increased physician work

Accepted Answer

MODIFIER -22

Question 2

UNUSUAL ANESTHESIA: 
• Use of anesthesia where no anesthesia or
local would be the norm
– Example: Highly agitated senile patient
• Only used with anesthesia codes
• Written report with submission of modifier
may be required

Accepted Answer

MODIFIER -23

Question 3

UNRELATED EVALUATION AND MANAGEMENT SERVICE BY THE SAME PHYSICIAN OR OTHER QUALIFIED HEALTH CARE PROFESSIONAL DURING A POSTOPERATIVE PERIOD: 
E/M Service not related to surgery is
separately billable
– Use -24 on E/M code only

Accepted Answer

MODIFIER -24

Question 4

SIGNIFICANT, SEPERATLY, IDENTIFIABLE  EVALUATION AND MANAGEMENT SERVICE BY THE SAME PHYSICIAN OR OTHER QUALIFIED HEALTH CARE PROFESSIONAL ON THE SAME DAY OF THE PROCEDURE OR OTHER SERVICE. :Documentation must support service
Code: Procedure + E/M-25

Accepted Answer

MODIFIER -25

Question 5

PROFESSIONAL COMPONENT: 
Professional component (physician, -26)
• Technical component (technician +
equipment, -TC)
• Example: Radiologist reviews x-rays (-26)
taken by supervised technician (-TC)

Accepted Answer

MODIFIER -26

Question 6

MANDATED SERVICES: 
Mandated by payer, workers’ comp, or
official body
• Not request of patient, patient’s family, or
another physician

Accepted Answer

MODIFIER -32

Question 7

PREVENTIVE SERVICES: 
Patient Protection and Affordable Care Act
of 2010 requires coverage without cost
• United States Preventive Services Task
Force grades preventive services
– Grade A: substantial
– Grade B: moderate

Accepted Answer

MODIFIER -33

Question 8

ANESTHESIA BY SURGEON:
Physician administers regional or general
anesthesia
– Acts as surgeon and anesthesiologist
• Only used with Surgery codes
• No separate payment when used on
Medicare patients

Accepted Answer

MODIFIER -47`

Question 9

BILATERAL PROCEDURE:
Bilateral
– Example: Procedure on hands
• Caution: Some codes describe bilateral
procedures; in these cases do not apply
modifier -50

Accepted Answer

MODIFIER -50

Question 10

MULTIPLE PROCEDURES :
Same Procedure, Different Sites
– Example: Multiple lacerations repaired
• Multiple Operation(s), Same Operative Session
• Procedure Performed Multiple Times
– Example: Trigger point injections (20552)

Accepted Answer

MODIFIER -51

Question 11

REDUCED SEVICES:
Service reduced from code description
• Physician directed reduction
• Documentation substantiates reduction
• Not for patients unable to pay fee
• Submit full charge, payer will adjust

Accepted Answer

MODIFIER -52

Question 12

DISCONTINUED PROCEDURE: 
#1  Surgical/diagnostic procedures
• Started then stopped due to patient’s
condition
• Does not apply to presurgical
discontinuance
#2 DO NOT USE -53 WHEN:
– Patient cancels scheduled procedure
– With E/M codes
– With tim

Accepted Answer

MODIFIER -53

Question 13

SURGICAL CARE ONLY:
Physician provides only procedure
(intraoperative)
• Documented patient transfer must be in
record
– Some payers require copy of transfer

Accepted Answer

MODIFIER -54

Question 14

POSTOPERATIVE MANAGEMENT ONLY:
Physician provides care only after hospital
discharge
– If transferred while patient hospitalized, report postop
management with subsequent hospital codes 99231-99233
• Documentation of transfer in medical record
• Sur

Accepted Answer

MODIFIER -55

Question 15

PREOPERATIVE MANAGEMENT ONLY:
• Physician provided only preoperative
care
• Not acceptable for Medicare
– Requires surgical code with modifier -56
Usual Reimbursement for Portions,
Surgical Package
• 10% preoperative
• 70% intraoperative
• 20% po

Accepted Answer

MODIFIER - 56

Question 16

DECISION FOR SURGERY:
• E/M, 99202-99499
• Medicine, 92012-92014 ophthalmologic
services
• Medicare: Only for preop period of major
surgery (day before or day of)
– 90 day global

Accepted Answer

MODIFIER -57

Question 17

STAGED OR RELATED PROCEDURE OR SERVICE BT THE SAME PHYSICIAN OR OTHER QUALIFIED HEALTH CARE PROFESSIONAL DURING THE POSTOPERATIVE PERIOD:
# 1 • Subsequent procedure planned or related
to the first surgery
– During postop of previous surgery in series

Accepted Answer

MODIFIER -58

Question 18

DISTINCT PROCEDURAL SERVICE:
#1 Different session or encounter
• Different procedure
• Different site
• Separate incision, excision, lesion, injury
• Do not use when another HCPCS modifier is appropriate
#2 MS established four HCPCS subset modifiers

Accepted Answer

MODIFIER -59

Question 19

MULTIPLE PROCEDURES: 
List most resource intense first (highest RVU
value)
• Next other procedure(s) + -51 (unless code is
-51 exempt or an add-on code)
• Usual payment: 1st procedure 100%, 2nd 50%,
3rd 25%
• Medicare: 1st procedure paid 100%, 2nd–

Accepted Answer

MODIFIER -51

MODIFIERS

CPT MODIFIERS

Question	Answer
INCREASED PROCEDURAL SERVICES: Indicates services significantly greater than usual • Accompanied by written report with supportive documentation • Describes increased physician work	MODIFIER -22
UNUSUAL ANESTHESIA: • Use of anesthesia where no anesthesia or local would be the norm – Example: Highly agitated senile patient • Only used with anesthesia codes • Written report with submission of modifier may be required	MODIFIER -23
UNRELATED EVALUATION AND MANAGEMENT SERVICE BY THE SAME PHYSICIAN OR OTHER QUALIFIED HEALTH CARE PROFESSIONAL DURING A POSTOPERATIVE PERIOD: E/M Service not related to surgery is separately billable – Use -24 on E/M code only	MODIFIER -24
SIGNIFICANT, SEPERATLY, IDENTIFIABLE EVALUATION AND MANAGEMENT SERVICE BY THE SAME PHYSICIAN OR OTHER QUALIFIED HEALTH CARE PROFESSIONAL ON THE SAME DAY OF THE PROCEDURE OR OTHER SERVICE. :Documentation must support service Code: Procedure + E/M-25	MODIFIER -25
PROFESSIONAL COMPONENT: Professional component (physician, -26) • Technical component (technician + equipment, -TC) • Example: Radiologist reviews x-rays (-26) taken by supervised technician (-TC)	MODIFIER -26
MANDATED SERVICES: Mandated by payer, workers’ comp, or official body • Not request of patient, patient’s family, or another physician	MODIFIER -32
PREVENTIVE SERVICES: Patient Protection and Affordable Care Act of 2010 requires coverage without cost • United States Preventive Services Task Force grades preventive services – Grade A: substantial – Grade B: moderate	MODIFIER -33
ANESTHESIA BY SURGEON: Physician administers regional or general anesthesia – Acts as surgeon and anesthesiologist • Only used with Surgery codes • No separate payment when used on Medicare patients	MODIFIER -47`
BILATERAL PROCEDURE: Bilateral – Example: Procedure on hands • Caution: Some codes describe bilateral procedures; in these cases do not apply modifier -50	MODIFIER -50
MULTIPLE PROCEDURES : Same Procedure, Different Sites – Example: Multiple lacerations repaired • Multiple Operation(s), Same Operative Session • Procedure Performed Multiple Times – Example: Trigger point injections (20552)	MODIFIER -51
REDUCED SEVICES: Service reduced from code description • Physician directed reduction • Documentation substantiates reduction • Not for patients unable to pay fee • Submit full charge, payer will adjust	MODIFIER -52
DISCONTINUED PROCEDURE: #1 Surgical/diagnostic procedures • Started then stopped due to patient’s condition • Does not apply to presurgical discontinuance #2 DO NOT USE -53 WHEN: – Patient cancels scheduled procedure – With E/M codes – With tim	MODIFIER -53
SURGICAL CARE ONLY: Physician provides only procedure (intraoperative) • Documented patient transfer must be in record – Some payers require copy of transfer	MODIFIER -54
POSTOPERATIVE MANAGEMENT ONLY: Physician provides care only after hospital discharge – If transferred while patient hospitalized, report postop management with subsequent hospital codes 99231-99233 • Documentation of transfer in medical record • Sur	MODIFIER -55
PREOPERATIVE MANAGEMENT ONLY: • Physician provided only preoperative care • Not acceptable for Medicare – Requires surgical code with modifier -56 Usual Reimbursement for Portions, Surgical Package • 10% preoperative • 70% intraoperative • 20% po	MODIFIER - 56
DECISION FOR SURGERY: • E/M, 99202-99499 • Medicine, 92012-92014 ophthalmologic services • Medicare: Only for preop period of major surgery (day before or day of) – 90 day global	MODIFIER -57
STAGED OR RELATED PROCEDURE OR SERVICE BT THE SAME PHYSICIAN OR OTHER QUALIFIED HEALTH CARE PROFESSIONAL DURING THE POSTOPERATIVE PERIOD: # 1 • Subsequent procedure planned or related to the first surgery – During postop of previous surgery in series	MODIFIER -58
DISTINCT PROCEDURAL SERVICE: #1 Different session or encounter • Different procedure • Different site • Separate incision, excision, lesion, injury • Do not use when another HCPCS modifier is appropriate #2 MS established four HCPCS subset modifiers	MODIFIER -59
MULTIPLE PROCEDURES: List most resource intense first (highest RVU value) • Next other procedure(s) + -51 (unless code is -51 exempt or an add-on code) • Usual payment: 1st procedure 100%, 2nd 50%, 3rd 25% • Medicare: 1st procedure paid 100%, 2nd–	MODIFIER -51

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