What is the 23 modifier used for?
Asked by: Maria Brown | Last update: August 1, 2025Score: 4.7/5 (12 votes)
What is a 24 modifier used for?
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 a 22 modifier used for?
Modifier -22 is to reflect additional work that is not typically part of the procedure, but does not qualify for its own procedure code. Depending on the documentation submitted, JHHP may or may not allow additional reimbursement.
What is CPT code 23?
Append modifier 23 to an anesthesia code when the provider administers general anesthesia for a procedure that does not normally require it.
What is the 26 modifier used for?
A complete service/procedure where both the technical and professional components are performed by a single provider. Modifier 26 is appended to billed codes to indicate that only the professional component of a service/procedure has been provided. It is generally billed by a physician.
What is a Modifier in Medical Coding? CPT and HCPCS Modifiers for Beginners
What is modifier 27 used for?
The CPT defines modifier –27 as “multiple outpatient hospital evaluation and management encounters on the same date.” HCFA will recognize and accept the use of modifier –27 on hospital OPPS claims effective for services on or after October 1, 2001.
What is a 25 modifier used for?
Modifier 25 is appended to indicate that a significant, separately identifiable E/M service was performed by the same physician or other QHP on the same date.
When to use modifier 23?
General Use of Modifier 23
Append Modifier 23 to an anesthesia procedure code to indicate that a procedure normally performed under local anesthesia or with a regional block required general anesthesia. Documentation shall support the reason that general anesthesia was required.
What is code 23 in medical billing?
Incorrect payment or adjustment by prior payer(s): This code may be triggered if the prior payer(s) made an error in processing the claim, resulting in an incorrect payment or adjustment. It could be due to miscalculations, misinterpretation of the claim details, or system glitches.
What is the 33 modifier?
By appending modifier 33, the provider alerts the insurer that a covered preventive service was provided, and that patient cost-sharing does not apply.
What is a 55 modifier used for?
Postoperative management only. Use this modifier to indicate that payment for the postoperative, post-discharge care is split between two or more physicians where the physicians agree on the transfer of postoperative care.
What is modifier 21 used for?
Use modifier -21, “Prolonged Evaluation and Management Services,” when an E/M service takes more time than is usually required for the highest level of service within a given E/M category.
What is modifier 59?
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 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 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 32?
32 - Mandated Services: Services related to mandated consultation and/or related services (eg, third party payer, governmental, legislative or regulatory requirement) may be identified by adding modifier 32 to the basic procedure.
What does code 23 mean?
When you receive denial code 23, this means that your denied claim is due to the impact of prior payer(s) adjudication. This includes payments and/or adjustments. You can find this information on the electronic remittance advice (ERA) and explanation of benefits (EOB) sent back by the payer.
What is CO 18?
CO-18 – DOUBLE BILLING
Insurers use denial code CO-18 to reject duplicate claims. This occurs when the same service is billed more than once, adjustments are not indicated on resubmitted claims, or the same service is performed multiple times a day without the appropriate modifiers.
What is code 20 in medical billing?
Denial code 20 means that the injury or illness being claimed is covered by the liability carrier. In other words, the healthcare provider's claim for reimbursement has been denied because the responsibility for payment lies with another party, such as an insurance company or a liability carrier.
What is modifier 24 used for?
Use CPT modifier 24 for unrelated evaluation and management service during a postoperative (global) period. The global period of a major surgery is the day prior to, day of and 90 days after the surgery.
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 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.
When to use modifier 26?
What you need to know. Modifier 26 is defined as the professional component (PC). The PC is outlined as a physician's service, which may include technician supervision, interpretation of results and a written report. Use modifier 26 when a physician interprets but does not perform the test.
Does 99213 need a modifier 25?
If the E/M is not bundled into the stress test, then the Cardiologist's coder can use modifier 25 to indicate that these two services were separate and significant: 99213-25, 93015.