Append to a service that is performed on the hands, feet, eyelids, coronary artery or left and right side of the body.
Why we are requiring these modifiers?
These modifiers assist in identifying the highest level of specificity for coding of services along with reduce duplicate denials. Utilizing the most specific modifier(s) may also prevent denials associated with NCCI edit criteria, resulting in the decrease for medical record reviews and appeals.
Please note:
- Anatomical modifiers should not be utilized with modifier 50 (bilateral modifier) – please see our bilateral modifier web page for use of this modifier
- Anatomical modifiers should be utilized when the procedure or service is performed unilaterally to identify additional services rendered (reflects services are not duplicates)
- Reporting an anatomical modifier for procedures such as skin lesions or anatomical sites not specific to a body region may result in denials
- Modifiers 59, XU, XS, XP, XE should not be utilized in place of an anatomical modifier – please code with the most specific modifiers
- Anatomic modifiers should align with any ICD-10 diagnosis codes that designates laterality (ie. Diagnosis is for RT leg, anatomic modifier should also indicate RT leg); Diagnosis codes to the highest level of specificity
- Reporting an anatomical modifier with an unspecific lateral diagnosis code (diagnosis has specific RT, LT, or bilateral diagnosis codes) may result in denials.
- Services with anatomic modifiers are subject to the multiple procedure reductions (when applicable). Get more information