Can a CPT code have two modifiers?
Asked by: Liliane Langworth | Last update: October 7, 2025Score: 4.4/5 (28 votes)
Can you use both modifiers 25 and 57?
Both Major and Minor Surgeries on the Same Day When a decision for surgery includes both major and minor surgeries and is made the day of surgery, the E&M billed for the decision must have both modifier –57 and modifier –25 appended.
Can modifier 58 and 82 be billed together?
This modifier should be removed and the service(s) resubmitted with HCPCS modifier AS or CPT modifier 80, 81 or 82. It is generally not appropriate to submit CPT modifier 58 with these CPT codes.
When multiple modifiers are applied to one CPT code, how do you determine the correct sequencing of the modifier codes?
If you code two pricing modifiers that include either a professional or technical component (26 or TC), always use the 26 or TC first, followed by the second pricing modifier. If you have two payment modifiers, for example 51 and 59, enter 59 first and 51 second.
Can RT and LT modifiers be used together?
Do not use the combination RTLT modifier on the same claim line and bill with 2 UOS. Claim lines for HCPCS codes requiring use of the RT and LT modifiers, billed without the RT and/or LT modifiers or with the RTLT on a single claim line, will be rejected as incorrect coding.
What is a Modifier in Medical Coding? CPT and HCPCS Modifiers for Beginners
Can you use two modifiers on one CPT code?
CPT modifiers are added to the end of a CPT code with a hyphen. In the case of more than one modifier, you code the “functional” modifier first, and the “informational” modifier second.
What are the two types of modifiers that can be combined?
Modifiers give additional information about nouns, pronouns, verbs, and themselves to make those things more definite. There are two types of modifiers: adjectives and adverbs.
What are the rules for modifier sequencing?
The proper sequencing order for modifiers is as follows: 1) pricing, 2) payment, and 3) location. Location modifier is always reported last in any coding scenario. Modifiers 26 and TC are examples of pricing modifiers while modifiers 51 and 59 are examples of payment. RT and LT are examples of location modifiers.
Which modifier indicates that multiple modifiers are needed?
Modifier 51 Multiple Procedures
It applies to: Different procedures performed at the same session.
What 2 types of modifiers may be used with anesthesia codes?
Pricing modifiers must be placed in the first modifier field to ensure proper payment (AA, AD, QK, QX, QY, and QZ). Informational modifiers are used in conjunction with pricing modifiers and are placed in the second modifier position (QS, G8, G9, and 23).
Which modifiers go first?
The payment modifier should be placed first and then any informational modifiers follow. A payment modifier example is -58, -79. These modifiers tell the payer why a surgery should be paid a certain way.
Can you use modifier 59 and RT together?
Don't add modifiers 59, XE, XS, XP, XU to either code to report 2 procedures for the same side of the body. If you performed 2 procedures on different sides of the body, you may report them with modifiers LT and RT as appropriate.
What is a 58 modifier used for?
Modifier 58 is defined as a staged or related procedure performed during the postoperative period of the first procedure by the same physician. A new postoperative period begins when the staged procedure is billed.
Can modifier 58 and 59 be billed together?
Shouldn't they be billed with modifier 58? No, because although the “same day” could technically be called part of “the post-operative period,” the definition of modifier 59 clearly focuses on “the same day.” That's much more specific than “post-operative.” Further, this is a non-E/M service.
When should a 57 modifier be used?
Modifier 57 should be appended to any E/M service on the day of or the day before said procedure when the E/M service results in the decision to go to surgery. This informs the payer that the physician determined the surgery was medically necessary. Modifier 57 should only be appended to E/M codes.
What is the modifier 52 rule?
Modifier -52 is used to indicate partial reduction or discontinuation of radiology procedures and other services that do not require anesthesia. The modifier provides a means for reporting reduced services without disturbing the identification of the basic service.
Can you use both modifier 25 and 57?
These modifiers can be used separately, though Good also details certain situations in which both can be used together to accurately represent the services provided.
How many modifiers can be used for one procedure?
If appropriate, more than one modifier may be used with a single procedure code; however, are not applicable for every category of the CPT codes. Some modifiers can only be used with a particular category and some are not compatible with others.
How do you know if a CPT code needs a modifier?
- The service or procedure has both professional and technical components.
- More than one provider performed the service or procedure.
- More than one location was involved.
- A service or procedure was increased or reduced in comparison to what the code typically requires.
What are modifier rules?
Modifier Basics
A modifier is a word, phrase, or clause that modifies—that is, gives information about—another word in the same sentence. For example, in the following sentence, the word "burger" is modified by the word "vegetarian": Example: I'm going to the Saturn Café for a vegetarian burger.
What is the modifier 25 rule?
Modifier 25 should be appended to the office or other outpatient visit code to indicate that a significant, separately identifiable E/M service was provided on the same date as the preventive medicine E/M service, and the appropriate preventive medicine E/M service is additionally reported without a modifier.
What is the modifier 53 rule?
Appropriate use modifier 53:
This modifier is used to report a service or procedure when the service or procedure is discontinued after anesthesia is administered to the patient.
What is a dangling modifier example?
Example: Walking toward the forest, the sun began to set. (In this example, “walking toward the forest” is a dangling modifier since it sounds as if the sun is walking toward the forest.) Revision: Walking toward the forest, I watched as the sun began to set. (The actor, I, is named as the subject of the sentence.)
When using multiple modifiers in what order are they sequenced?
Answer: The basic rule of modifier sequencing is to sequence payment, or level one, modifiers before informational, or level two, modifiers. Additionally, if you have a modifier that affects pricing, that will be sequenced before any payment eligibility modifier.
How to place modifiers correctly?
A modifier is a word or phrase that describes or clarifies another word or phrase in a sentence. The placement of modifiers is important for clear and accurate communication. In English, modifiers should be placed as close as possible to the word or phrase they're modifying to avoid confusion.