Does 97012 require a modifier?
Asked by: Audra Sporer | Last update: April 8, 2025Score: 4.3/5 (4 votes)
Does the CPT code 97012 require a modifier?
Modifiers are crucial to signal unique circumstances in billing. For instance, use Modifier 59 if CPT Code 97012 was performed independently of other billed services. Modifiers clarify billing scenarios to insurers, reducing the risk of bundling or claim rejections.
How do I 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 CPT codes need a 59 modifier?
Another common use of modifiers 59 or XE is for surgical procedures, non-surgical therapeutic procedures, or diagnostic procedures performed during different patient encounters on the same day that can't be described by 1 of the more specific NCCI PTP-associated modifiers – in other words, 24, 25, 27, 57, 58, 78, 79, ...
What insurance companies require the GP modifier?
The use of the GP modifier is required now on all claims to United Health Care and their affiliates, VA claims, Medicare claims, Blue Cross Blue Shield of Michigan and now Anthem Blue Cross of California.
Telehealth Modifiers You Might Not be Aware of FR, FQ, 93, and XE & 59, and are Audio Sessions Ok?
What is CPT code 97012?
CPT 97012 - Mechanical Traction
CPT defines CPT Code 97012 as "Application of modality to one or more areas; traction, mechanical." CPT Code 97012 is a supervised modality.
When should a GP modifier be used?
Use a GP modifier in any case where there could be confusion as to which provider delivered services to a patient, such as in any interdisciplinary therapy setting.
When to use 59 or 51 modifier?
Modifier -51 would be attached because the biopsy is the lesser-valued procedure done at the same session, and modifier -59 would be attached to indicate that the biopsy, which is normally bundled with excision of the same lesion, was done on a separate lesion from the one that was excised.
When should a modifier be used?
“Its use allows two E/M services or a procedure plus an E/M service that are distinctly different but required for the patient's condition to be appropriately reported and, therefore, appropriately paid,” the issue brief says. The use of modifiers provides supplementary information for payer policy requirements.
How do I know if a CPT code needs a laterality modifier?
The -RT and -LT modifiers should be used whenever a procedure is performed on one side. For instance, when reporting CPT code 27560 (closed treatment of patellar dislocation; without anesthesia), modifier -RT or -LT should be appended if only one knee is treated.
How do you know which modifier to use?
The correct modifier to use is determined by payor preference. There can be instances where a CPT code is further defined by an HCPCS modifier, for example, to describe the side of the body the procedure is performed on, such as left (modifier -LT) or right (modifier -RT).
What is an example of a 59 modifier?
59 Modifier Examples
An example of appropriate use of the 59 modifier might be if a physical therapist performed both 97140 (manual therapy) and 97530 (therapeutic activity) in the same visit. Normally these procedures are considered inclusive.
How do you know if a CPT code needs a modifier?
- A service or procedure has both a professional and technical component, but only one component is applicable.
- A service or procedure was performed by more than one physician or in more than one location.
Can you bill 97140 and 97012 together?
Yes, you can bill 97140 and 97012 together. However, it's important to note that billing these codes together requires the use of modifier 59 to indicate that the services were separate and distinct.
Does CPT require a modifier?
According to CPT, the situations when the use of a modifier may be appropriate are: 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.
How do you know if something is a modifier?
Modifiers are words, phrases, and clauses that affect and often enhance the meaning of a sentence. Modifiers offer detail that can make a sentence more engaging, clearer, or specific. The simplest form of a modifier would be an adjective or adverb.
When assigning a CPT code What is the purpose of a modifier?
A modifier indicates that a service or procedure performed has been altered by some specific circumstance but not changed in its definition or code. For example, if a physician performed a cholecystectomy on a patient who was morbidly obese, a cholecystectomy would still be reported.
What is the correct use of a modifier?
Always place modifiers as close as possible to the words they modify. When you place modifiers too far away from the words that they modify, you change the meaning of the sentence, creating what is called a misplaced modifier error.
When to use modifier 50?
Use modifier 50 to report bilateral procedures performed during the same operative session by the same physician in either separate operative areas (e.g., hands, feet, legs, arms, ears) or in the same operative area (e.g., nose, eyes, breasts).
What is the order of modifiers in CPT?
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.
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.
When should modifier 51 be used?
Modifier 51 Multiple Procedures indicates that multiple procedures were performed at the same session. It applies to: Different procedures performed at the same session. A single procedure performed multiple times at different sites.
When should modifier 57 be used?
Modifier -57 is appended to office visits the same day or within three days of a major surgery (90-day global period). It indicates the office visit includes the decision for the major procedure.
When to use GV and GW modifier?
The GV and GW modifiers are used for Medicare hospice patients. The GV modifier is used to report services related to a patient's hospice care, while the GW modifier is used to report services that are unrelated to the patient's hospice care.