You have performed a service or procedure that meets the definition of a Current Procedural Terminology (CPT®) code but was altered in some way. How do you communicate this when you submit your claim for payment?
Most often you would report the service appended with a modifier. This will give the payer additional information and a better understanding of the service you provided.
Modifiers may be used to indicate that
Some modifiers will only be used by specialists, while others will be used most frequently by primary care physicians. However, any physician of any specialty may report a CPT code with a modifier when appropriate. Medical record documentation must support the services performed.
Payers may recognize all modifiers or only some. Also, some payers develop policies for modifier use that are inconsistent with CPT guidelines. Consequently, using modifiers can be confusing. For that reason, in this and subsequent newsletters, those...