CPT Modifiers

CPT Modifiers

Proper use of modifiers with procedure codes is essential to submitting correct claims. The AMA’s CPT code book includes HCPCS Level II codes and modifiers, while the HCPCS code book includes HCPCS Level II codes and related modifiers.

Resources about modifiers on the CMS website include:
• The “Modifier 59” article explains the correct use of -59 as a distinct procedural service
http://www.cms.gov/Medicare/Coding/NationalCorrectCodInitEd/downloads/modifier59.pdf

• The Physician Quality Reporting System (PQRS) web page explains the incentive payment to practices
with eligible professionals who satisfactorily report data on their claims;
http://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/PQRS/index.html

• The Physician Bonuses web page outlines whether or not a modifier is required to receive the Health
Professional Shortage Area (HPSA) bonus payment;
http://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/HPSAPSAPhysicianBonuses/index.html

• Chapters of the “Medicare Claims Processing Manual” (IOM Pub. 100-04) also offer modifier information.
For example, Chapter 30 includes information related to modifiers for Advance Beneficiary Notices (ABNs).
http://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/Downloads/clm104c30.pdf

 

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