When would you use a CG modifier?

When should a modifier be used?

Medical coders use modifiers to tell the story of a particular encounter. For instance, a coder may use a modifier to indicate a service did not occur exactly as described by a CPT^® or HCPCS Level II code descriptor, but the circumstance did not change the code that applies.

Is the GC modifier only for Medicare?

Use is limited to use in Medicare, Medicaid, or other programs administered by the Centers for Medicare & Medicaid Services (CMS).

Do you need modifier 25 with ultrasound?

The modifier 25 is added to the E/M visit to indicate that there was a separately identifiable E/M on the same day of a procedure/ultrasound. The modifier stops the bundling of the E/M visit into the procedure/ultrasound.

Do chiropractors use GP modifier?

UHC Claims Will Require GP Modifier For Therapy Codes

So if you render and bill for 1-2 regions of CMT (98940) and therapeutic exercise (97110), then the 97110 chiropractic CPT code will receive the GP modifier.

Who bills the GC modifier?

What is the GC modifier and when do I use it? Government payers (Medi-Cal and Medicare) require the GC modifier to be appended to E/M codes when a resident, under the direction of a teaching physician in an approved teaching program, is involved in the care of a patient.

How do you know if a code needs a modifier?

What modifier should be added to 99213?

Get to know them

In this case, you may submit codes for both a preventive service (such as 99396) and a regular office visit (such as 99213) by attaching -25 to the office-visit code.

What is the proper use of GC modifier?

A GC Modifier is a modifier added to a CPT code for service(s) performed in part by a resident under the direction of a teaching physician (TP). When should the GC modifier be used? A GC Modifier is used when a resident, under the direction of a teaching physician, is involved in the management and care of a patient.

What is CPT code 99213 CG?

The 99213 code is specifically used for office visits that involve moderate medical decision-making and complexity. It is suitable for patients with established conditions or those with new, uncomplicated symptoms. These services encompass a range of primary care services that address the immediate needs of patients.

Can G0511 be telehealth?

RHCs and FQHCs can continue using telehealth with pandemic waivers intact for all of 2025. G0511 consists of care management services defined by specific CPT® and HCPCS codes when 20 minutes of general care management or behavioral management is performed in a calendar month.

When not to use modifier 25?

Modifier 25 should not be used when: ❌ The sole purpose of the encounter is for the procedure (e.g., lesion removal), and there is no documented medical necessity for a separate E/M service.

What is the modifier for ultrasound?

Modifier -26 is the most common modifier used with ultrasounds in the emergency department. When reporting diagnostic ultrasound interpretations by the ED physician, modifier -26 (Professional Component Only) should always be reported to signify that only the professional component is being billed.

Is modifier 25 needed for EKG?

Yes, you need to add a -25 modifier to your E&M service when billing in conjunction with an EKG or injection admin service done on same DOS. You're sure to get a bundling denial without it.

Does modifier GC affect payment?

GC modifier has no impact on payment unless it is discovered on appeal that the teaching physician failed to document and electronically sign their attestation note. If you have a teaching physician supervising a resident, the GC modifier must be appended to that service.

What modifier is not accepted by Medicare?

GZ - Service is not covered by Medicare

The GZ modifier identifies that 1) an item or service is expected to be denied as not reasonable and necessary, and 2) no advance notice of non-coverage was supplied to the member.

What is the difference between GE and GC modifier?

Modifier GC –This service has been performed in part by a Resident under the direction of a Teaching Physician. Modifier GE –This service has been performed by a Resident without the presence of a Teaching Physician under the Primary Care Exception.

What are examples of modifier 25 use?

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. A 25-year-old female (new patient) with a soft tissue breast lesion is referred to the surgeon by her primary care physician.

When should modifier 26 be used?

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.

How do you know if a modifier is used correctly?