CPT Modifier 90
Reference Lab - Used to indicate a lab test sent to an outside lab. e.g., lab procedure performed by a party other than the treating or reporting laboratory. NOTE: Outside lab name, address and UPIN must be included on the claim. Section 20 must be marked "yes" and your actual cost for each test, net any discounts, must be included in the charges section.
CPT Modifier 26
Professional component only - Use to indicate that the physician component is reported separately from the technical component for the diagnostic procedure performed
CPT Modifier GH
Diagnostic mammogram converted from screening mammogram on the same day.
CPT Modifier QP
Documentation is on file showing that the laboratory test(s) was ordered individually or ordered as a CPT
recognized panel other than automated profile codes
CPT Modifier QR
Repeat clinical diagnostic laboratory test performed on the same day to obtain subsequent reportable test value(s) (separate specimens taken in separate encounters)
CPT Modifier QW
CLIA waived test
CPT Modifier TC
Technical component only - Used to indicate that the technical component is reported separately from the professional component for the diagnostic procedure performed
Monday, February 8, 2010
use of 26 and TC modifiers
use of modifiers 26 and TC
Recently Palmetto GBA has noticed a number of diagnostic services being filed on the same day by different providers. In some of these instances one provider has filed for either the professional or the technical component while the other provider has filed a global charge. It is important to make sure you only file for the portion of the services you rendered.
If you are billing for the interpretation or the technical component of a diagnostic procedure, p lease ensure that you use the appropriate modifier. If you are performing the professional component of a service you should indicate this by using the 26 modifier. If you are performing the technical component of the service you will need to indicate this using the TC modifier. Please note that only one service for each component is appropriate per service and absence of a modifier indicates a global service and failure to utilize the appropriate modifier will result in an overpayment made to your office.
Recently Palmetto GBA has noticed a number of diagnostic services being filed on the same day by different providers. In some of these instances one provider has filed for either the professional or the technical component while the other provider has filed a global charge. It is important to make sure you only file for the portion of the services you rendered.
If you are billing for the interpretation or the technical component of a diagnostic procedure, p lease ensure that you use the appropriate modifier. If you are performing the professional component of a service you should indicate this by using the 26 modifier. If you are performing the technical component of the service you will need to indicate this using the TC modifier. Please note that only one service for each component is appropriate per service and absence of a modifier indicates a global service and failure to utilize the appropriate modifier will result in an overpayment made to your office.
modifiers used with E/M codes (EVALUATION AND MANAGEMENT modifers)
CPT modifier 21
Prolonged evaluation and management services - Use only with highest level of care code for the category when the face-to-face or floor/unit service provided is prolonged or otherwise greater than that usually required for the highest level code.
CPT modifier 24
Unrelated E/M service during a post-op period - Use with E/M codes only to indicate that the E/M performed during a postoperative period for a reason(s) unrelated to the original procedure. Modifier 24 applies to unrelated E/M services for either a MAJOR or MINOR surgical procedure.- Failure to use modifier when appropriate may result in denial of the E/M service
CPT modifier 25
Separately identifiable service on same day as procedure - Use with E/M codes only to indicate that the patient’s condition required a significant, separately identifiable E/M service above and beyond the other service provided or beyond the usual pre- and postoperative care for the procedure performed- Failure to use modifier when appropriate may result in denial of the E/M service
CPT modifier 57
Decision for surgery - Use with E/M codes billed by the surgeon to indicate that the E/M service resulted in the decision for surgery (E/M visit was NOT usual pre-operative care). For E/M visits prior to MAJOR surgery (90 day post-op period) only.- Failure to use modifier when appropriate may result in denial of the E/M service.
Prolonged evaluation and management services - Use only with highest level of care code for the category when the face-to-face or floor/unit service provided is prolonged or otherwise greater than that usually required for the highest level code.
CPT modifier 24
Unrelated E/M service during a post-op period - Use with E/M codes only to indicate that the E/M performed during a postoperative period for a reason(s) unrelated to the original procedure. Modifier 24 applies to unrelated E/M services for either a MAJOR or MINOR surgical procedure.- Failure to use modifier when appropriate may result in denial of the E/M service
CPT modifier 25
Separately identifiable service on same day as procedure - Use with E/M codes only to indicate that the patient’s condition required a significant, separately identifiable E/M service above and beyond the other service provided or beyond the usual pre- and postoperative care for the procedure performed- Failure to use modifier when appropriate may result in denial of the E/M service
CPT modifier 57
Decision for surgery - Use with E/M codes billed by the surgeon to indicate that the E/M service resulted in the decision for surgery (E/M visit was NOT usual pre-operative care). For E/M visits prior to MAJOR surgery (90 day post-op period) only.- Failure to use modifier when appropriate may result in denial of the E/M service.
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