Does CPT 99213 need a modifier?

Do I need a modifier for 99214?

Does 99214 need a modifier? Modifiers can be used with 99214 if applicable. For example, you can add Modifier 25 to the E/M visit with 99214 if there was a “separately identifiable E/M on the same day of a procedure” (source: ACC). Or add modifier 22 if the procedure was extra complex.

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.

What documentation is required for 99213?

- Relevant documentation: To support the 99213 code, include pertinent information such as the reason for the visit, history of present illness, review of systems, physical examination, assessment, and plan of care.

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.

Does modifier 25 go on office visit or procedure?

Modifier 25 is used to signify that when a separate identifiable evaluation-and-management (E/M) service was performed, which can refer to two evaluation-and-management (E/M) services, or a procedure plus an E/M service.

What is an example of a 99213 visit?

An example of a 99203 or 99213 is a sinus infection treated with an antibiotic. Although the prescription makes the risk component moderate, the one acute uncomplicated illness is a low-complexity problem, and there are no data points.

Is 99213 a preventive code?

However, if you bill an additional office visit code (for example, 15 minute expanded problem visit code 99213 with modifier 25), this is NOT considered a preventive service, and may be subject to deductibles, copays or coinsurance.

Is CPT code 99213 covered by Medicare?

Medicare will pay a physician for an AWV service and a medically necessary service, e.g. a mid-level established office visit, Current Procedural Terminology (CPT) code 99213, furnished during a single beneficiary encounter.

When to use a modifier in billing?

Can you bill 99213 for telehealth?

During the COVID-19 public health emergency, many physiatrists are performing standard office visits via telehealth. These services should be billed using standard E/M codes. For example, a level 3 office visit provided to an established patient via telehealth should be billed using code 99213.

Can you bill 99213 with 20610?

Use the E/M code with a modifier (for example, 99213-25), as well as the knee joint aspiration procedure code 20610. Thus, when a new problem requires more than a cursory review, the visit generally qualifies for an E/M with modifier -25.

What is the correct order of CPT modifiers?

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.

When should modifier 50 be used?

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).

Do CPT add on codes need a modifier?

There are instances where multiple procedures are performed but modifier 51 is not appropriate. Modifier 51 is not appended to add-on codes. For example, modifier 51 would not be appended to CPT code 64462 as it is an add-on code and would be used for any additional injection sites per its definition.

How to bill for 99213?

CPT code 99213 is used for an established patient office or other outpatient visit that requires a medically appropriate history and/or examination and low level of medical decision-making along with 20 minutes of encounter time.

What level of visit is 99213?

What is CPT Code 99213? Level 3 code in the Evaluation and Management (E/M) category. CPT 99213 specifically describes a moderate-complexity office or outpatient visit.

What is the CPT code for outpatient office visit?

CPT® code 99212: Established patient office or other outpatient visit, 10-19 minutes.

What is the modifier 25 rule?

Modifier 25 is a way to identify a “significant, separately 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,” according to the CPT 2024 code set.

Does CPT 97110 require a modifier?

You should attach the GP modifier to CPT 97110 when billing for therapeutic exercises in an outpatient setting, which helps payers easily interpret the treatment as physical therapy-related.

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, ...