Correct use of CPT Modifiers to Maximize Reimbursement

According to the Current Procedural Terminology (CPT) book, a modifier is a “means to report or indicate that a service or procedure that has been performed has been altered by some specific circumstance but not changed in its definition or code.”

List of CPT Modifiers with Description

• 22:  Increased Procedural Services (not for E/M services)
• 24: Unrelated Evaluation and Management Service by the Same Physician or Other Qualified Health Care Professional During a Postoperative Period
• 25: Significant, Separately Identifiable Evaluation and Management Service by the Same Physician or Other Qualified Health Care Professional on the Same Day of the Procedure or Other Service
• 33: Preventive Services
• 50: Bilateral Procedure
• 51: Multiple Procedures
• 53: Discontinued Procedure
• 54: Surgical Care Only
• 57: Decision for Surgery
• 58: Staged or Related Procedure or Service by the Same Physician or Other Qualified Health Care Professional During the Postoperative Period
• 59: Distinct Procedural Service
• 62: Two surgeons
• 66: Surgical Team
• 78: Unplanned Return to the Operating/Procedure Room by the Same Physician or Other Qualified Health Care Professional Following Initial Procedure for a Related Procedure During the Postoperative Period
• 79: Unrelated Procedure by the Same Physician or Other Qualified Health Care Professional During the Postoperative Period
• 81: Minimum Assistant Surgeon
• 82: Assistant Surgeon (when qualified resident surgeon not available)

List of HCPCS Modifiers with Description

• AA: Anesthesia services personally performed by the anesthesiologist
• AD: Supervision, more than four procedures
• AH: Clinical psychologist
• AJ: Clinical Social Worker (CSW) rendered a diagnostic or therapeutic service
• AS: Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery
• E1: Upper left, eyelid
• GA: Waiver of Liability Statement Issued, as Required by Payer Policy
• GC: Service performed in part by a resident under the direction of a teaching physician
• GE: Service performed by a resident without the presence of a teaching physician under the primary care exception (except ambulance services)
• GX: Notice of liability issued, voluntary under payer policy
• GY: Item or service statutorily excluded, does not meet the definition of any Medicare benefit
• GZ: Item or service expected to be denied as not reasonable and necessary
• P1: A normal healthy patient
• P2: A patient with mild systemic disease
• P3: A patient with severe systemic disease
• P4: A Patient with severe systemic disease that is a constant threat to life
• P5: A moribund patient who is not expected to survive without the operation
• P6: A declared brain-dead patient whose organs are being removed for donor purposes
• PT: Colorectal cancer screening test; converted to diagnostic test or other procedure
• Q6: Service furnished by a locum tenens physician
• Q7: One Class A Finding
• Q8: Two Class B Findings
• Q9: One Class B and Two Class C Findings
• QK: Medical direction of two, three, or four concurrent anesthesia procedures
• QW: Clinical Laboratory Improvement Amendment (CLIA) waived test
• QX: Qualified non-physician anesthetist with medical direction by a physician
• QY: Medical direction of one CRNA/AA by an anesthesiologist
• QZ: Certified Registered Nurse Anesthetist (CRNA) without medical direction by a physician
• RT: Right side
• TC: Technical Component

Using incorrect modifiers can result in denial of medical claims. Health care providers must use modifiers correctly to support the medical services offered to their patients.