What are modifiers used for in medical billing?
Asked by: Lamont Paucek | Last update: April 23, 2025Score: 5/5 (46 votes)
What is the purpose of a modifier in medical billing?
Medical coders use modifiers to tell the story of a particular encounter. For instance, a coder may use a modifier to indicate a service did not occur exactly as described by a CPT® or HCPCS Level II code descriptor, but the circumstance did not change the code that applies.
What is the E1, E2, E3, and E4 modifier?
CPT® provides one modifier for each eyelid: E1 for upper left, E2 for lower left, E3 for upper right, and E4 for lower right. The general rule is to use the E modifiers when a procedure can be performed on any one of the four eyelids -- but real-world coding and billing don't always allow you to.
What is the 96 and 97 modifier?
Modifier 96 is used to identify habilitative services and procedures. Modifier 96 is also to be used in the event that habilitative services rendered can be considered either habilitative or rehabilitative. Modifier 97 is used to identify rehabilitative services and procedures.
What is a 27 modifier used for?
Modifier 27 is for hospital/outpatient facilities to use when multiple outpatient hospital Evaluation and Management (E/M) encounters occur for the same member on the same date of service. Modifier 27 is exclusive to hospital outpatient departments, including hospital emergency departments, clinics and critical care.
What is a Modifier in Medical Coding? CPT and HCPCS Modifiers for Beginners
What is the 59 modifier used for?
Modifier 59 Distinct Procedural Service indicates that a procedure is separate and distinct from another procedure on the same date of service. Typically, this modifier is applied to a procedure code that is not ordinarily paid separately from the first procedure but should be paid per the specifics of the situation.
What is modifier 99 used for?
99 Used when two or more modifiers are necessary to completely delineate a service; the multiple modifiers used must be explained in the Remarks field (Box 80)/Additional Claim Information field (Box 19) of the claim or on an attachment.
What is 23 modifier used for?
Modifier 23 (Unusual Anesthesia) This modifier describes a procedure usually not requiring anesthesia (either none or local), but due to unusual circumstances, is performed under general anesthesia.
What is a 78 modifier used for?
Definitions. Current Procedural Terminology (CPT®) modifier 78 is used to describe an unplanned return to the operating room or procedure room during the global period of the initial procedure by the same physician.
What is modifier 51 used for?
CPT guidelines explain the 51 modifier should apply when “multiple procedures, other than E/M services, are performed at the same session by the same individual. The additional procedure(s) or service(s) may be identified by appending modifier 51 to the additional procedure or service code(s).”
What is 57 modifier?
CPT modifier 57 may be used to report the decision for surgery for certain codes. This modifier may be used to indicate that an evaluation and management (E/M) service performed on the same day or the day before a major surgery (090 global days) by the surgeon resulted in the decision to perform the procedure.
What is modifier 22 used for?
Modifier -22: Increased Procedural Services. This modifier is used to identify a service that requires significantly greater effort, such as increased intensity, time, technical difficulty of procedure, severity of patient's condition, physical and mental effort required, than is usually needed for that procedure.
What is a 25 modifier used for in medical billing?
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.
What is the use of modifier 50 in medical billing?
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 best modifier?
The best universal modifier is Godly or Demonic. The two modifiers only differ in knockback, a stat that is not considered very useful (or even beneficial) in many situations. The difference in knockback is also negligible enough that Godly and Demonic can be treated as the same modifier.
What is modifier 30 used for?
§ 9789.12. 15 California Specific Modifiers
A modifier -30 is a situational billing element which alerts when a consultation is required for a Medical-Legal Evaluation.
What is modifier 90 used for?
Modifier 90 is used when laboratory procedures are performed by a party other than the treating or reporting physician and the laboratory bills the physician for the service. For example, the physician (in his office) orders a CBC, the physician draws the blood and sends the specimen to an outside laboratory.
What is modifier 33 used for?
Current Procedural Terminology (CPT) modifier 33 can be used when billing for ACA-designated preventive services with a commercial payer. The addition of modifier 33 communicates to a commercial payer that a given service was provided as an ACA preventive service.
What is modifier 60 used for?
The CPT manual introduced modifier -60 in 2001 to allow providers to indicate when a procedure was more complex than normal due to an altered surgical field.
What is modifier 73 used for?
Modifier -73 is used by the facility to indicate that a surgical or diagnostic procedure requiring anesthesia was terminated due to extenuating circumstances or to circumstances that threatened the well being of the patient after the patient had been prepared for the procedure (including procedural pre-medication when ...
What is a 52 modifier used for?
Modifier -52 identifies that the service or procedure has been partially reduced or eliminated at the physician's discretion. The basic service described by the procedure code has been performed, but not all aspects of the service have been performed.
What is modifier 80 used for?
Current Procedural Terminology (CPT®) Modifier 80 - CPT Modifier 80 represents assistant at surgery by another physician. This assistant at surgery is providing full assistance to the primary surgeon.
What is modifier 92 used for?
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) ...
What is modifier 95 used for?
-95: Synchronous telemedicine service rendered via a real-time interactive audio and video communications system.