Using code modifiers

Accurately coding claims the first time helps to ensure timely claim processing and reimbursement and avoids the need for appeals. Code modifiers help further describe a procedure code without changing the definition of the code. Modifiers can be found in the CPT (Current Procedural Terminology) and HCPCS (HCFA Common Procedural Coding System) code books.

Appropriate use of modifiers supports accurate coding. If your claim isn’t correctly coded when you first submit it and your claim is denied, submit a corrected claim with the accurate coding. Do not submit an appeal on an incorrectly coded claim.

Effective May 1, 2024, appeals received on incorrectly coded claims will result in the denial being upheld. Remember, you only have one opportunity to appeal per claim.

To support accurate coding, in the pages linked below we provide guidance on how to use some of the more commonly misused modifiers.