What Is Modifier In Coding?

What is a CPT code modifier?

CPT modifiers (also referred to as Level I modifiers) are used to supplement information or adjust care descriptions to provide extra details concerning a procedure or service provided by a physician.

Code modifiers help further describe a procedure code without changing its definition..

Does 99214 need a modifier?

The modifier 25 is added to the E/M visit to indicate that there was a separately identifiable E/M on the same day of a procedure. 99214 – Office or other outpatient visit for the evaluation and management of an established patient, which requires at least 2 of these 3 key components.

What is a 59 modifier?

Modifier 59 is used to identify procedures/services, other than E/M services, that are not normally reported together, but are appropriate under the circumstances. … Only if no more descriptive modifier is available, and the use of modifier 59 best explains the circumstances, should modifier 59 be used.

What does KX modifier mean?

ensured coverage criteriaModifier KX Use of the KX modifier indicates that the supplier has ensured coverage criteria for the billed is met and that documentation does exist to support the medical necessity of item. Documentation must be available upon request.

What is Gc modifier used for?

A GC Modifier is a modifier added to a CPT code for service(s) performed in part by a resident under the direction of a teaching physician (TP). When should the GC modifier be used? A GC Modifier is used when a resident, under the direction of a teaching physician, is involved in the management and care of a patient.

What does modifier am mean?

A. Physician Services, Team Member.–Modifier AM. B. Physician Assistant Services, Non-Team Member.–Modifier AN.

What is a payment modifier?

Modifier: Two digit numeric or alpha-number descriptor that is used by providers to indicate that a service or procedure has been altered by a specific circumstance, but the procedure code and definition is unchanged. 4. Modifiers Affecting Payment: Modifiers which impact how a claim or claim line will be reimbursed.

What does the 25 modifier mean?

The Current Procedural Terminology (CPT-4) manual gives the definition of modifier -25 as. follows: (From CPT-4, copyright American Medical Association) “Significant, Separately Identifiable Evaluation and Management Service by the Same Physician on the Same Day of the Procedure or Other Service.”

What is a GX modifier?

Modifier GX The GX modifier is used to report that a voluntary Advance Beneficiary Notice of Noncoverage (ABN) has been issued to the beneficiary before/upon receipt of their item because the item was statutorily noncovered or does not meet the definition of a Medicare benefit.

What is the 26 modifier?

The CPT modifier 26 is used to indicate the professional component of the service being billed was “interpretation only,” and it is most commonly submitted with diagnostic tests, including radiological procedures. When using the 26 modifier, you must enter it in the first modifier field on your claim.

Does modifier 25 or 95 go first?

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 a modifier 50?

Modifier 50 is used to report bilateral procedures that are performed during the same operative session by the same physician in either separate operative areas (e.g. hands, feet, legs, arms, ears), or one (same) operative area (e.g. nose, eyes, breasts).