Which modifier should go first?
Asked by: Alyson Kovacek | Last update: December 11, 2025Score: 4.4/5 (62 votes)
Which modifier should be listed first?
In medical coding, modifiers are used to give additional information about a procedure, service, or supply, and modifiers that will have the biggest impact on reimbursement are normally sequenced first. These modifiers typically fall into one of three categories: (1) Pricing, (2) Payment, or (3) Location.
What is the order of modifiers in billing?
The payment modifier should be placed first and then any informational modifiers follow. A payment modifier example is -58, -79. These modifiers tell the payer why a surgery should be paid a certain way.
Does modifier 25 or 95 go first?
Since both modifier 25 and 95 can impact payment, list modifier 25 first.
Does the 51 or 59 modifier go first?
There is no real need to use both - EVER. Doing so is unnecessary. The -59 modifier tells you that this is a distinct procedure from the first procedure (for example two distinct lesions). The -51 modifier would tell you that you performed a second (or third or fourth...)
Modifer 51 and 59 in Medical Coding -- What's the Difference and which one should you use??
Does modifier 59 go on primary or secondary?
It should only be used if no other modifier more appropriately describes the relationship of the two or more procedure codes.” This is different from the way CPT defines modifier 59. In other words, a physician can use modifier 59 to bill the secondary, additional, or lesser procedure in an NCCI edit combination.
What is the modifier 51 rule?
Modifier 51 Multiple Procedures indicates that multiple procedures were performed at the same session. It applies to: Different procedures performed at the same session. A single procedure performed multiple times at different sites.
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 the 59 modifier used for?
Definitions. Modifier 59 describes a distinct procedural service, and is used to identify procedures and services that are not normally reported together.
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.
How is modifier placed correctly?
Typically, modifiers are placed right beside the noun they're modifying. Usually, this means right before or after the noun: My calico cat is always by my side.
How do you arrange modifiers?
- Always place modifiers as close as possible to the words they modify. ...
- A modifier at the beginning of the sentence must modify the subject of the sentence. ...
- Your modifier must modify a word or phrase that is included in your sentence.
Does modifier order matter?
The order of modifiers that wrap their target view, on the other hand, often matters quite a lot, and a different modifier order can end up yielding a very different result.
Which modifier goes first 26 or 50?
Always add 26 before any other modifier. If you have two payment modifiers, a common one is 51 and 59, enter 59 in the first position.
When should you use modifier 95?
The modifier may depend on the type of service. -95: Synchronous telemedicine service rendered via a real-time interactive audio and video communications system.
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 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 50 used?
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 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 the 55 modifier for?
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.
What is modifier 53 used for?
Appropriate use 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 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 62 used for?
Two surgeons. Under some circumstances, the individual skills of two or more surgeons are required to perform surgery on the same patient during the same operative session.
What is modifier 58?
To start, modifier 58 is a surgical-specific modifier, used to indicate a staged or related procedure or service by the same physician during the postoperative period.