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Billing Modifiers Cheat Sheet Form
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People also ask
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What are modifiers used for in billing?
A modifier is a code that provides the means by which the reporting physician can indicate that a service or procedure that has been performed has been altered by some specific circumstance but has not changed in its definition or code. -
How do you determine modifier order?
ORDER OF REPORTING: If you have two pricing modifiers, the most common scenario is likely to involve 26 and another modifier. Always add 26 before any other modifier. If you have two payment modifiers, a common one is 51 and 59, enter 59 in the first position. If 51 and 78, enter 78 in the first position. -
Do modifiers have to be in order?
Multiple modifiers can be added to a single CPT code, however, this must be done in a certain order. Generally speaking, a modifier that affects payment should be listed first, followed by any modifier that is descriptive in nature. -
How do you know which modifier goes first?
In the case of more than one modifier, you code the “functional” modifier first, and the “informational” modifier second. The distinction between the two is simple: you always want to list the modifiers that most directly affect the reimbursement process first. -
How do I know which modifier to use?
The correct modifier to use is determined by payor preference. There can be instances where a CPT code is further defined by a HCPCS modifier, for example, to describe the side of the body the procedure is performed on such as left (modifier -LT) or right (modifier -RT). -
Which modifier goes first 95 or 25?
When billing a telemedicine service (using modifier 95) and another service that requires modifier 25 to be used in addition, the general rule is to report the “payment” modifier before any other descriptive modifier. Since both modifier 25 and 95 can impact payment, list modifier 25 first. -
What is the billing order for modifiers?
The general order of sequencing modifiers is (1) pricing (2) payment (3) location. Location modifiers, in all coding situations, are coded “last”. -
Which modifier goes first 50 or 51?
You should list the most resource-intense (highest paying) procedure first, and append modifier 51 to the second and subsequent procedures.
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