Modifier 27 in facility coding

Modifier 27 is for hospital/outpatient facilities to use when multiple outpatient hospital Evaluation and Management (E/M) encounters occur for the same member on the same date of service. Modifier 27 is exclusive to hospital outpatient departments, including hospital emergency departments, clinics and critical care.

Guidelines

• Modifier 27 should be appended only to E/M service codes within the range of 92002- 92014, 99201-99499, and with HCPCS codes G0101 and G0175.
• Hospitals may append modifier 27 to the second and subsequent E/M code when more than one E/M service is provided to indicate that the E/M service is “separate and distinct E/M encounter” from the service previously provided that same day in the same hospital with different providers or different hospital outpatient setting.
• When reporting modifier 27, report with condition code G0 when multiple medical visits occur on the same day in the same revenue centers.