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.
- 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
Coronary artery modifiers
Eye lid modifiers
Finger/digit of hand modifiers
Toe/digit of foot modifiers
Laterality (side of body) modifiers
Clinical edit: Anatomical Modifiers Use Max Frequency
Claims will deny excess units when any provider bills more than one unit of service with an anatomical modifier E1-E4 (Eyes), FA-F9 (Fingers), and TA-T9 (Toes).
Anatomical modifiers of E1-E4, FA-F9, TA-T9 have a maximum allowable of one unit per anatomical site for a given date of service. Any service billed with an anatomical modifier for more than one unit of service will be adjusted accordingly.
- AI modifier
- Anatomic modifiers
- Anesthesia modifiers
- AT: Active treatment
- GA and GY: Medicare non-coverage notification
- GN, GO & GP: Therapy type
- UD and UA: Treated and released or admitted/transferred (Medicaid only)
- 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
- 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
- 59: Distinct procedural service
- 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