What is a 55 modifier used for?
Asked by: Alanna D'Amore | Last update: April 28, 2025Score: 4.5/5 (51 votes)
When should modifier 54 be used?
The provider who performed surgical care should append modifier 54 to the appropriate CPT® code(s) to describe the surgery performed. Per CMS, the modifier signals that the surgeon intends to transfer “all or part of the post-operative care” to another provider.
What is CPT code 55?
•CPT modifier 55 - for postoperative management only. The claim for the surgical care and the claim(s) for the postoperative care must contain the same date of service and the same surgical procedure code, with the services distinguished by the use of the appropriate modifier. Appropriate. Date.
What is modifier 59 most commonly 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 56 used for?
Modifier 56 is used for preoperative management only when a qualified health care professional performed the preoperative care and evaluation and another performed the surgical procedure.
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What is the 55 modifier used for?
Modifier 55
Postoperative Management Only. When a physician or other qualified health care professional performs the postoperative management and another physician performed the surgical procedure, the postoperative component may be identified by appending this modifier to the surgical procedure.
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 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 62 used for?
Two surgeons. Under some circumstances, the individual skills of two or more surgeons are required to perform surgery on the same patient during the same operative session.
What is code 55?
Denial code 55 is used when a procedure, treatment, or drug is considered experimental or investigational by the payer. This means that the payer does not consider the specific procedure, treatment, or drug to be proven or established as effective for the patient's condition.
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.
What is a 52 modifier?
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.
What is modifier 53 used for?
Appropriate use modifier 53:
Bill modifier 53 with the CPT code for the service furnished. 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 modifier 80?
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 a 26 modifier?
• Modifier 26 is appended when a physician provides the professional component only of the global fee. and when the physician prepares a written interpretation and report. • Modifier 26 should only be appended to codes which are listed in the CMS NPFSRVF as modifier 26. appropriate.
What is modifier 59?
Definitions. Modifier 59 describes a distinct procedural service, and is used to identify procedures and services that are not normally reported together.
When to use modifier 90?
Independent laboratories shall use modifier 90 to identify all referred laboratory services. A claim for a referred laboratory service that does not contain the modifier 90 is returned as unprocessable if the claim can otherwise be identified as being for a referred service.
What is 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 modifier 57 used for?
What You Need To Know. Modifier 57 is used to indicate an Evaluation and Management (E/M) service resulted in the initial decision to perform surgery either the day before a major surgery (90 day global) or the day of a major surgery.
What is modifier 66 used for?
Definitions. Current Procedural Terminology (CPT®) modifier 66 describes when three or more surgeons of same or different specialties work together as primary surgeons performing distinct part(s) of a surgical procedure.
What is a 24 modifier?
Modifier 24 is defined as an unrelated evaluation and management service by the same physician or other qualified health care professional during a post-operative period.
What is the 54 modifier?
Modifier 54
Surgical Care Only. When a physician or other qualified health care professional performs a surgical procedure and another provides preoperative and/or postoperative management, surgical services may be identified by adding this modifier to the usual procedure code.
What is modifier 67?
HELOXY™ Modifier 67 is a commercial grade, diglycidyl ether of 1,4-butanediol and is primarily used as a reactive diluent or viscosity reducer for all classes of epoxy resins.
What is modifier 58 for?
Defining Modifier 58
To start, modifier 58 is a surgical-specific modifier, used to indicate a staged or related procedure or service by the same physician during the postoperative period.