Which scenario qualifies for modifier 58?
Asked by: Scottie Gusikowski | Last update: January 8, 2026Score: 4.1/5 (14 votes)
When should modifier 58 be used?
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.
What situation is modifier 59 most commonly 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.
Which scenario qualifies for modifier 22?
Specific instances when you might use modifier 22 include substantial factors (e.g., large tumors, excessive scarring, anatomical variants) directly interfering with the procedure, excessive intraoperative blood loss, significant trauma extensive enough to complicate the procedure, or even morbid obesity in a patient ...
Which of the following scenarios qualifies for modifier 25?
Modifier 25 should be appended to the office or other outpatient visit code to indicate that a significant, separately identifiable E/M service was provided on the same date as the preventive medicine E/M service, and the appropriate preventive medicine E/M service is additionally reported without a modifier.
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In what scenario would you use modifier 25?
Modifier 25 is used to signify that when a separate identifiable evaluation-and-management (E/M) service was performed, which can refer to two evaluation-and-management (E/M) services, or a procedure plus an E/M service.
Which of the following scenario modifier 26 is used for?
DEFINING MODIFIER 26
Most often, you'll see this among diagnostic testing procedures such as ultrasounds or CT scans. When the professional component of one such procedure is performed separately, the specific service performed by the physician may be identified by adding the modifier 26.
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.
When to use modifier 24 examples?
Use Modifier 24 on an E/M when: An unrelated E/M service is performed beginning the day after the procedure, by the same physician, during the 10 or 90-day post-operative period. Documentation indicates the service was exclusively for treatment of the underlying condition and not for post-operative care.
When can modifier 57 be used?
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.
When to use 25 and 59 modifiers?
Only if no more descriptive modifier is available, and the use of modifier 59 best explains the circumstances, should modifier 59 be used. Note: Modifier 59 should not be appended to an E/M service. To report a separate and distinct E/M service with a non-E/M service performed on the same date, see modifier 25.”
What is modifier 22?
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.
When to use modifier 62?
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. This may be required because of the complex nature of the procedure(s) and/or the patient's condition.
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 the Medicare Code 58?
Denial code 58 is used when the payer determines that the treatment or service was provided in a location that is considered inappropriate or invalid according to their guidelines.
Can modifier 58 and 82 be billed together?
This modifier should be removed and the service(s) resubmitted with HCPCS modifier AS or CPT modifier 80, 81 or 82. It is generally not appropriate to submit CPT modifier 58 with these CPT codes.
What is modifier 58 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.
Which scenario qualifies for modifier 25?
Modifier 25 is a way to identify a “significant, separately identifiable evaluation and management service by the same physician or other qualified health care professional on the same day of the procedure or other service,” according to the CPT 2024 code set.
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.
What is modifier 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 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.
When to use modifier 26 examples?
Example use of Modifier 26
A patient seeks treatment at the Emergency Room (ER) of a hospital for a head injury. The facility performs a CT of the head without contrast (CPT® Code 70450). The film is sent by courier to a noted local radiologist's office for review.
What is modifier 25 examples?
Modifier 25 may be used in the rare circumstance of an E/M service the day before a major operation and represents a significant, separately identifiable service; it likely would be associated with a different diagnosis (for example, evaluation of a cough that might affect the operation).
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.