Using Modifiers

August 13th, 2018 - Chris Woolstenhulme, QCC, CMCS, CPC, CMRS
Categories:   Billing   Modifiers  
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Modifiers offer supplemental information and provide additional details without changing the procedure codes definition and are always two digits. Modifiers are required for proper billing and at times used with NCCI edits, however, two or more NCCI -associated modifiers on the same line will be denied. In addition, NCCI modifiers should not be placed in the first position unless it is the only modifier being used.

CPT Modifiers also are known as Level I modifiers are used with CPT codes to indicate specific circumstances when reporting a service or procedure.

Level II Modifiers are Alpha Numeric and are found in the Healthcare Common Procedure Coding System (HCPCS). Level II modifiers are used to report procedures and supplies.  HCPCS modifiers are primarily used for non-physician services that are not included in CPT codes.

Placement of a modifier depends on the situation and is reported on the code line next to the code it pertains to.   

  • Pricing modifiers are always in the first position and result in automated pricing changes. For example, when reporting modifier 50 - Bilateral Procedure performed at the same session on an anatomical site, payment is reduced.  Modifier 50 is used to report a procedure was performed bilaterally.
  • Informational modifiers do not affect payment and are reported after any pricing modifiers such as RT-Right or LT-Left.

Some modifiers can be used with HCPCS as well as CPT codes such as LT or RT. 

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