What is the modifier for procedure with E&M?
Asked by: Suzanne Reichert III | Last update: June 29, 2025Score: 4.2/5 (62 votes)
What is the EP modifier used for?
How is the EP modifier used? Early and Periodic Screen, therefore any service provided in an Early and Periodic Screen should have an EP modifier. It is important to append an EP modifier to these services, as some of these CPT codes are also used for services provided to adults.
What is the XE modifier used for?
We define these modifiers as follows: XE – “Separate Encounter, a service that is distinct because it occurred during a separate encounter.” Only use XE to describe separate encounters on the same DOS. XS – “Separate Structure, a service that is distinct because it was performed on a separate organ/ structure.”
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.
What is modifier 57 and 25?
When the patient presents with the knowledge that the procedure is going to be done and no other conditions are addressed, the E/M is typically not supported, and Modifier 25 cannot be used. Use Modifier 57 when an E/M service leads to the decision to perform surgery.
E&M Coding — Preventive E&M Coding with Modifier
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 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 25 modifier?
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.
When to use modifier 55?
POSTOPERATIVE MANAGEMENT ONLY: WHEN ONE PHYSICIAN PERFORMS THE POSTOPERATIVE MANAGEMENT AND ANOTHER PHYSICIAN HAS PERFORMED THE SURGICAL PROCEDURE, THE POSTOPERATIVE COMPONENT MAY BE IDENTIFIED BY ADDING THE MODIFIER -55 TO THE USUAL PROCEDURE NUMBER OR BY USE OF THE SEPARATE FIVE DIGIT MODIFIER CODE 09955.
When to use modifier 95?
-95: Synchronous telemedicine service rendered via a real-time interactive audio and video communications system.
What is the EB modifier?
anticancer chemotherapy. o Modifier EB - Erythropoietic stimulating agent (ESA) administered to treat anemia due to anticancer radiotherapy. o Modifier EC - Erythropoietic stimulating agent (ESA) administered to treat anemia not due to anticancer radiotherapy or anticancer chemotherapy.
When to use modifier kx?
Use of the KX modifier indicates that the supplier has ensured coverage criteria for the DMEPOS billed is met and that documentation does exist to support the medical necessity of item.
What is a GY modifier used for?
GY modifier is added to claims in which the item or service is statutorily excluded, does not meet the definition of any Medicare benefit. Correct Use. Append when services are provided under statutory exclusion from Medicare Program. It is not necessary to provide patient with an ABN for these situations.
What is the ET modifier used for?
Emergency treatment (dental procedures performed in emergency situations).
What is a 52 modifier used for?
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 a PS modifier?
The PS modifier is appropriate for PET/CT imaging of recurrent prostate cancer since recurrence occurs after the completion of initial treatment. The PI modifier is used to inform the initial treatment strategy of tumors that are biopsy proven or strongly suspected of being cancerous based on other diagnostic tests.
What is the 57 modifier used for?
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 the 50 modifier used for?
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 54 modifier used for?
Modifier 54
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.
When to use modifier 24?
- This modifier may be used to indicate that an evaluation and management (E/M) service or eye exam, which falls within the global period of a major or minor surgery and which is performed by the surgeon, is unrelated to the surgery. ...
- This modifier may only be submitted with E/M and eye exam codes.
What is modifier 59 used for?
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 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 a 22 modifier?
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 51 modifier?
Modifier 51 is defined as multiple surgeries/procedures. Multiple surgeries performed on the same day, during the same surgical session. Diagnostic Imaging Services subject to the Multiple Procedure Payment Reduction that are provided on the same day, during the same session by the same provider.