Use CPT Modifier to Get the Reimbursement You Deserve

written by : Nancy Rose

CPT modifier is an additional feature of the CPT to indicate that specific circumstances have changed the performed service. Modifiers play an important role in explaining the insurance companies or payers that the additional procedures that were performed which do not look like to be separately paid are in fact justified.

Here are some examples of commonly used CPT modifiers:

50 : Indicates a procedure that not already defined as bilateral was performed on both sides of the patient's body at the same episode of care.

51 : When multiple surgeries are performed during the same operative session. Most payers pay 100 percent for the first procedure, but reduce the reimbursement on the second, third, and fourth procedures.

59 : This CPT modifier is used to indicate that a procedure was distinct or separate from the other procedures performed on the same date. This modifier tells the payer that the doctor has not submitted a duplicate claim.

62 : A single procedure performed jointly by co-surgeons. Here, each surgeon bills with the same code and the payment to each of them is usually 62.5 percent of the normal amount.

76 : Repeat procedure by the same doctor. Often used with radiological procedures, performed more than once on the same date.

79 : Unrelated procedure or service by the same physician during the post operative period. This modifier is the surgical equivalent of modifier - 24.

91 : Repeat clinical lab. This modifier is used when more than one result are required in the course of treatment on the same day. A word of caution here -do not use this modifier in case of equipment failure.

There are many other CPT modifiers which identify the type of provider and supervision - the key objective is to get the reimbursement you truly deserve.