Modifier

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.

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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.

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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