What modifier do I use for an EKG?
Asked by: Dovie Towne | Last update: May 19, 2025Score: 5/5 (11 votes)
Does an EKG need a modifier?
Some carriers want you to append modifier 25 onto your E/M code (such as 99201-99215) when the cardiologist performs an EKG (such as 93000, Electrocardiogram, routine ECG with at least 12 leads; with interpretation and report) in diagnostic cases.
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.
Does 93000 need a modifier 26?
Does CPT 93000 Need a Modifier? For CPT code 93000, which pertains to a complete electrocardiogram, the following modifiers may be applicable: 1. Modifier 26 - Professional Component: This modifier is used when only the professional component of the service is being billed.
What is a 73 modifier 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 ...
12 Lead ECG Placement example
What is a 79 modifier used for?
Modifier 79 is used to indicate an unrelated procedure performed by the same physician during the postoperative period of the original surgery. When the procedure is related to the original surgery or is a staged (anticipated) surgery, it falls under the global period and should not use Modifier 79.
How to bill for EKG?
The CPT codes for EKG include 93000, 93005, 93010, 93040, 93041, and 93042. These codes cover various aspects of the EKG procedure, such as the number of leads used, interpretation, and report.
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 the modifier 76 for EKG?
Repeat Procedures by Same Physician
When the same physician interprets serial x-rays or EKGs performed on the same day, CPT modifier 76 must be submitted to indicate the service was repeated subsequent to the original procedure.
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.
When to use 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 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.
Is EKG covered by Medicare?
Electrocardiogram (EKG or ECG) screenings
Part B covers an EKG or ECG (as a one-time screening with a referral from your doctor as part of your "Welcome to Medicare" preventive visit and as a diagnostic test.)...
What is an ECG vs EKG?
Both terms mean the same thing: an electrocardiogram. EKG comes from the German word, which uses “k” instead of “c” in both parts of the word. However, it's different from an echocardiogram, which is an ultrasound that creates images of your beating heart.
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 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.
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.
What is the modifier for EKG?
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.
Does insurance pay for EKG?
You can reduce the amount you pay for an EKG to less than $100 by getting insurance coverage. Most medical insurances cover 80-100% of ECG testing. Meaning, you'll only have to pay small amounts as copays with the cover, depending on the insurance plan you choose.
What is modifier 26?
• 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 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 73 used for?
Use modifier 73 to report discontinued outpatient/hospital ambulatory surgical center (ASC) procedure prior to the administration of anesthesia. Physicians should not use this modifier. This is only appropriate for use by the ASC.
What is modifier 77 used for?
CPT modifier 77 is used to report a repeat procedure by another physician. This modifier may be submitted with EKG interpretations or X-rays that require a second interpretation by another physician.