What modifier is needed for 99204?
Asked by: Melyssa Tromp Jr. | Last update: October 2, 2025Score: 4.3/5 (6 votes)
When to use GT or 95 modifier?
The two most commonly used modifiers are the GT modifier for telehealth service rendered via interactive audio and video telecommunications systems, and the 95 modifier for synchronous telemedicine service rendered via a real-time interactive audio and video communications system.
What are the requirements for a 99204 office visit?
To bill for a 99204 CPT code, the physician must meet the following requirements: The patient must be an established patient. It means the patient has had a previous visit with the physician or the physician's group. The visit must be performed in the physician's office or outpatient.
What is the 25 modifier used for?
The Current Procedural Terminology (CPT) definition of Modifier 25 is as follows: Modifier 25 – this Modifier is used to report an Evaluation and Management (E/M) service on a day when another service was provided to the patient by the same physician or other qualified health care professional.
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 Modifier in Medical Coding? CPT and HCPCS Modifiers for Beginners
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 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 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.
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.
Can you use modifier 25 on 99211?
The use of modifier 25 requires that the key components be documented with the E&M service. Therefore, CPT code 99211 cannot be appended with modifier 25. Only the line item on the claim for CPT code 99211 appended with modifier 25 will be denied.
Does cpt code 99204 need a modifier?
What modifier is needed for 99204? Modifiers for 99204 depend on the specific circumstances of the billing situation (e.g., modifier 25 for a significant, separately identifiable service by the same physician on the same day of the procedure or other service or modifier 22 for a significantly more complex procedure).
What is allowable for 99204?
CPT Code 99204 Reimbursement Rate (Medicare, 2025): $163.35
In the past years, this E/m code has been paid $169.93 by Medicare in 2021.
How to code an office visit?
To report, use 99202. Office or other outpatient visit for the evaluation and management of a new patient, which requires these 3 key components: An expanded problem focused history; An expanded problem focused examination; Straightforward medical decision making.
Does modifier 25 go before 95?
When billing a telemedicine service (using modifier 95) and another service that requires modifier 25 to be used in addition, the general rule is to report the “payment” modifier before any other descriptive modifier. Since both modifier 25 and 95 can impact payment, list modifier 25 first.
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 96?
Physical Therapy Billing Modifier 96 & Modifier 97
Habilitative treatment would include all treatments that help patients develop a skill, movement, or function that they were not able to learn on their own.
What is modifier 27?
Modifier 27 is for hospital/outpatient facilities to use when multiple outpatient hospital E/M encounters occur for the same member on the same date of service.
Which of the following is required for a CPT code 99204 for a new patient?
For a level-4 visit to be a 99204 CPT code, not only must the patient be new, but the encounter needs to include a comprehensive history as well as a physical exam. A comprehensive history should include: Patient's present illness.
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 modifier is 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 a 95 modifier?
-95: Synchronous telemedicine service rendered via a real-time interactive audio and video communications system.
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 57?
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 25?
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.