Introduction
A modifier is a two-character code (numeric, alphanumeric, or alphabetic) that’s appended to a CPT (Current Procedural Terminology) or HCPCS (Healthcare Common Procedure Coding System) code. Its job? To provide additional information about the service or procedure performed.
Why Are Modifiers Important?
- ✅ They help avoid claim denials by giving payers a clearer picture.
- ✅ They support medical necessity.
- ✅ They ensure the provider gets paid accurately for the work performed.
- ✅ They prevent duplicate denials when more than one service is billed on the same day.
Types of Modifiers
Modifiers fall into two major categories:
1. CPT Modifiers (Level I Modifiers)
Developed by the American Medical Association (AMA), these modifiers are used with CPT codes to explain:
- What was done
- How it was done
- Why it differed from the standard
🔢 These are numeric, ranging from -22 to -99.
2. HCPCS Modifiers (Level II Modifiers)
Created by CMS (Centers for Medicare & Medicaid Services), these modifiers are alphanumeric (usually two letters) and used mainly with HCPCS codes, but sometimes with CPT codes too.
💡 These provide more specific information, especially for Medicare/Medicaid claims — like which side of the body a procedure was performed on or if a service was for a durable medical device.
Modifier List
| Modifier | Description |
|---|---|
| 22 | Increased Procedural Services |
| 23 | Unusual Anesthesia |
| 24 | Unrelated Evaluation and Management Service by the Same Physician During a Postoperative Period |
| 25 | Significant, Separately Identifiable Evaluation and Management Service by the Same Physician on the Same Day of the Procedure or Other Service |
| 26 | Professional Component |
| 50 | Bilateral Procedures |
| 51 | Multiple Procedures |
| 53 | Discontinued Procedure |
| 54 | Surgical Care Only |
| 56 | Preoperative Management Only |
| 57 | Decision for Surgery |
| 58 | Staged or Related Procedure or Service by the Same Physician During the Postoperative Period |
| 59 | Distinct Procedural Service |
| 62 | Two Surgeons |
| 63 | Procedure Performed on Infants less than 4 kg. |
| 66 | Surgical Team |
| 76 | Repeat Procedure by Same Physician |
| 77 | Repeat Procedure by Another Physician |
| 78 | Return to the Operating Room for a Related Procedure During the Postoperative Period |
| 79 | Unrelated Procedure or Service by the Same Physician During the Postoperative Period |
| 80 | Assisted Surgeons |
| 81 | Minimum Assistant Surgeons |
| 82 | Assistant Surgeon (when qualified surgeon no available) |
| LT | Left side (used to identify procedures performed on the left side of the body) |
| RT | Right side (used to identify procedures performed on the right side of the body |
| GV | Attending physician not employed or paid under arrangement by the patient’s hospice provider. |
| GW | Service not related to the hospice patient’s terminal condition. |
| TC | Technical Component. |
| U1 | Perinatal care provider completed prenatal or postpartum depression screening and behavioral health need identified (positive screen) |
| U2 | Perinatal care provider completed prenatal or postpartum depression screening with no behavioral health need identified (negative screen) |