Does cpt code 93040 need a modifier?
Asked by: Dr. Lonzo Runolfsson | Last update: January 19, 2026Score: 4.4/5 (52 votes)
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 CPT codes need a 59 modifier?
For the NCCI, the primary purpose of CPT® modifier 59 is to indicate that two or more procedures are performed at different anatomic sites or during different patient encounters. It should only be used if no other modifier more appropriately describes the relationships of the two or more procedure codes.
What is CPT code 93040?
For example, when billing for CPT code 93040 (rhythm ECG, one to three leads; with interpretation and report), the individual modifiers 26 (professional component) and TC (technical component) are inclusive within this code and are therefore not separately reimbursable.
Can lab codes be billed with modifier 26?
Services with a value of “1” or “6” in the PC/TC Indicator field of the National Physician Fee Schedule may be billed with modifier 26. These are predominantly radiology services, but also include pathology, laboratory and medicine services.
Review of X EPSU Modifiers | Modifier 59 Alternatives
What CPT codes need modifier 26?
DEFINING MODIFIER 26
Most often, you'll see this among diagnostic testing procedures such as ultrasounds or CT scans. When the professional component of one such procedure is performed separately, the specific service performed by the physician may be identified by adding the modifier 26.
What is a modifier 25 with lab codes?
Modifier 25 is used to indicate that a patient's condition required a significant, separately identifiable evaluation and management (E/M) service above and beyond that associated with another procedure or service being reported by the same physician or other qualified health care professional (QHP) on the same date.
Does 93040 need a modifier?
If you interpret and report a rhythm ECG during the cardiovascular stress test encounter, don't report 93040 with or without modifier 59. You may report modifiers 59 or XE when you interpret and report the procedures in different encounters on the same day.
Can CPT 93000 and 93040 be billed together?
A rhythm ECG tracing (93040 or 93041) is included in a 12-lead ECG tracing (93000 or 93005). When several ECG rhythm (or monitor) strips from a single date of service are reviewed at a single setting, report only one unit of service, regardless of the number of strips reviewed.
What is modifier 76 used for?
CPT Modifier 76: 'Repeat procedure by same physician: The physician may need to indicate that a service was repeated the same day subsequent to the original service.
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.
When to use modifier 54?
The use of modifier 54 indicates the surgeon has transferred postoperative care (partial or total) to another provider, and the surgical code with modifier 55 appended will be billed by the receiving provider to whom the postoperative care was transferred.
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 I 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.
Does an EKG need a modifier?
Electrocardiogram (ECG or EKG) – CPT and ICD-10 Codes
If a physician performs only the interpretation and report (without the tracing), they should report CPT code 93010-not 93000 with modifier -26.
What is the 58 modifier for NCCI?
Modifier 58: Modifier 58 is defined by the CPT Professional as a “Staged or Related Procedure or Service by the Same Physician or Other Qualified Health Care Professional During the Postoperative Period.” It may be used to indicate that a procedure was followed by a second procedure during the post-operative period of ...
What is CPT code 93000 with modifier 59?
It indicates that the provider is billing for the use of equipment and the technician's time, excluding the interpretation. 3. Modifier 59 - Distinct Procedural Service: This modifier is used to indicate that the electrocardiogram was a distinct service from other procedures performed on the same day.
What are examples to use modifier 52?
Example One
A provider performs a unilateral tonsillectomy for a ten-year-old patient (CPT code 42820). In this case, apply modifier 52. This CPT assumes bilateral surgery, so to show that it was only performed on one side, or electively reduced, modifier 52 would be appropriate.
What is the modifier for a nebulizer treatment?
This code should be used to report nebulizer treatments done in the office. For multiple treatments on the same day, use units or the -76 modifier (on the second line of 94640). If doing a pre- and post-spirometry with the nebulizer treatment, do not report 94640. Use Code 94060, which includes all of these elements.
What procedure requires a 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).
When to use modifier 92?
Alternative Laboratory Platform Testing: When laboratory testing is being performed using a kit or transportable instrument that wholly or in part consists of a single use, disposable analytical chamber, the service may be identified by adding modifier 92 to the usual laboratory procedure code (HIV testing 86701-86703) ...
When not to use modifier 25?
Modifier 25 should not be used when: ❌ The sole purpose of the encounter is for the procedure (e.g., lesion removal), and there is no documented medical necessity for a separate E/M service.
When to use modifier 93?
-93: Synchronous telemedicine service rendered via telephone or other real-time interactive audio-only telecommunications system.