What are medical billing modifier codes?


Quick Answer

In medical billing, modifiers are two-digit codes that are attached to procedure codes that provide additional information about the procedure being billed. The addition or absence of a modifier influences whether insurance pays for the provider, reports Cahaba Government Benefit Administrators.

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Full Answer

Two common modifier codes are modifier 25 and modifier 57. Modifier 25 is attached to a billing claim to signify that a separate, significant service or procedure was performed on the same day as another service or procedure. Affixing a modifier 25 to the claim does not require two different diagnoses for the services or procedures in question, and it is prohibited when service resulted in a decision to perform major surgery. A modifier 57 is utilized to report a service that results in the decision to perform major surgery, provided the service occurred the day before or the day of the procedure, states University of Florida Health.

Modifier 24 indicates that a service was provided following an operation for reasons unrelated to the original procedure. Modifier 51 is used when multiple procedures are performed on the same day by the same provider, and is utilized by affixing the modifier to the secondary procedure. Additionally, the GC modifier signifies that services were performed by a resident or fellow operating under the supervision of a teaching physician, according to University of Florida Health.

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