|
Modifier/Description
|
CPT codes where modifier may apply
|
Reimbursement Impact
|
|
22-Unusual Procedural Service
|
99201-99499
10021-99199
|
Additional 20% of the allowable fee (pays 120% of fee)
|
|
26-Professional Component
|
70010-99199
|
Reduced % based on contracted fee schedule
|
|
50-Bilateral Procedure
|
10021-69990
|
Additional 50% of the allowable fee (pays 150% of the fee)
|
|
52-Reduced Services
|
All
|
Reduces the allowable fee by 20% (pays 80% of fee)
|
|
54-Surgical Care Only
|
10021-69990
|
Reduced the allowable fee by 30% (pays 70% of fee)
|
|
55-Postoperative Management Only
|
10021-69990
|
Reduced the allowable fee by 85% (pays 15% of the fee)
|
|
56-Preoperative Management Only
|
10021-69990
|
Reduced the allowable fee by 90% (pays 10% of the fee)
|
|
59-Distinct Procedural Services
|
All
|
Allows separate reimbursement for procedures that would otherwise
deny per code editing (e.g., separate excision site). If the code being billed
is subject to multiple surgery procedure reimbursement reduction, the applicable
reduction will also apply.
|
|
62-Co-Surgeons
|
10021-69990
|
Reduces the allowable fee by 35% (pays 65% of fee)
|
|
76-Repeat Procedure by Same Physician
|
10021-99199
|
Reduces the allowable fee by 20% (pays 80% of fee)
|
|
78-Return to the Operating Room for a Related Procedure during the Postoperative Period
|
10021-69990
|
Reduces the allowable fee by 30% (pays 70% of fee)
|
|
80-Assistant Surgeon*
|
10021-69990
|
Reduces the allowable fee by 80% (pays 20% of fee); mid-level
practitioners may not bill with this modifier; Service may be denied if the
procedure is not one that would normally warrant the services of an assistant
surgeon
|
|
81-Minimum Assistant Surgeon*
|
10021-69990
|
Reduces the allowable fee by 90% (pays 10% of fee); mid-level
practitioners may bill with this modifier; Service may be denied if the
procedure is not one that would normally warrant the services of an assistant
surgeon
|
|
82-Assistant Surgeon
(when qualified resident surgeon not available)*
|
10021-69990
|
Reduces the allowable fee by 80% (pays 20% of the fee); mid- level
practitioners may not bill with this modifier, use AS or 81 instead; Service may
be denied if the procedure is not one that would normally warrant the services
of an assistant surgeon
|
|
AS-Physician assistant, nurse practitioner, or clinical nurse
specialist service for assistant at surgery*
|
10021-69990 |
Reduces the allowable fee by 90% (pays 10% of fee); mid-level
practitioners may bill with this modifier; Service may be denied if the
procedure is not one that would normally warrant the services of an assistant
surgeon
|
|
TC-Technical component
|
70010-99199
|
Reduced % based on contracted fee schedule
|
