Modifiers are an integral part of Current Procedural Terminology (CPT®) coding. They provide the means by which a physician can report that a service or procedure was altered by some specific circumstances but not changed in its definition or code. Using modifiers may result in reduced denials and increased reimbursement. Effective use will certainly give the payer a more clear understanding of the services or procedures performed.

Modifiers may be used to indicate the following:

Not all modifiers are recognized by all payers. It is important to understand which payers recognize which modifiers. Unfortunately, nonrecognition may affect your reimbursement or result in inappropriate denials. Many payers have adopted all or some of the Centers for Medicare and Medicaid Services (CMS) National Correct Coding Initiative edits as their payment policies. While they may use these edits as a basis, they may adopt payment policies of their own.

In addition...

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