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.
- AI modifier
- Anatomic modifiers
- Anesthesia modifiers
- AT: Active treatment
- FT: Unrelated critical care services
- GA, GY and GZ: Medicare non-coverage notification
- GN, GO & GP: Therapy type
- JW, JZ modifiers
- UD and UA: Treated and released or admitted/transferred (Medicaid only)
- 59, XE, XS, XP, XU: Distinct services
- 22: Unusual procedural services
- 25: Significant service separate from E&M service
- 26 and TC: Professional and technical components
- 27: Multiple E/M services in hospital outpatient departments
- 33: Preventive service
- 50 & 51: Bilateral and multiple procedures
- 52: Reduced services
- 53: Discontinued procedure
- 54 & 55: Surgical care and post-op care
- 56: Pre-operative management only
- 57: E&M service same day or before major surgery
- 62: Two surgeons
- 73 & 74: Discontinued outpatient surgery
- 76 & 77: Repeated procedures, same day
- 78: Unplanned return to operating room
- 80, 81, 82: Assistant at surgery