|
Type
Key:
GP
=
Global Package Modifier
CCI
= related to bundling / CCI
E/M
only =
Appended to E/M codes only
#
= Related to number of surgeons
Oth
= All Others
|
$$
Key:
Û = $$ goes up;
Þ = $$ claim gets paid - without it claim would be denied;
Ü = $$ goes down;
Ú = $$ Stays the same (informational only)
|
|
|
Type
|
$$
|
E/M
|
Anesthesia
|
Surgery
|
Radiology
|
Path
& Lab
|
Medicine
|
ASC
& Hosp
|
Global
Package Modifiers
|
|
-24
|
Unrelated
E/M service by the same physician during a postop
period
|
GP
&
E/M
Only
|
Þ
|
E/M
|
|
|
|
|
|
|
|
-25
|
Significant
separately identifiable E/M service
|
GP&
E/M
Only
|
Þ
|
E/M
|
|
|
|
|
|
ASC
& Hosp
|
|
-57
|
Decision
for surgery
|
GP
&
E/M
Only
|
Þ
|
E/M
|
|
|
|
|
Medicine
|
|
|
-54
|
Surgical
care only
|
GP
|
Ü
|
|
|
Surgery
|
|
|
|
|
|
-55
|
Postoperative
management only
|
GP
|
Ü
|
|
|
Surgery
|
|
|
Medicine
|
|
|
-56
|
Preoperative
management only
|
GP
|
Ü
|
|
|
Surgery
|
|
|
Medicine
|
|
|
-58
|
Staged
or related procedure
|
GP
|
Þ
|
|
|
Surgery
|
Radiology
|
|
Medicine
|
ASC
& Hosp
|
|
-76
|
Repeat
procedure by same physician
|
GP
&
Oth
|
Ü,
Þ
|
|
|
Surgery
|
Radiology
|
|
Medicine
|
ASC
& Hosp
|
|
-77
|
Repeat
procedure by another physician
|
GP
|
Þ
|
|
|
Surgery
|
Radiology
|
|
Medicine
|
ASC
& Hosp
|
|
-78
|
Return
to OR for a related procedure during the postop
period
|
GP
|
ÜÞ
|
|
|
Surgery
|
Radiology
|
|
Medicine
|
ASC
& Hosp
|
|
-79
|
Unrelated
procedure or service by the same physician during
the postop period
|
GP
|
Þ
|
|
|
Surgery
|
Radiology
|
|
Medicine
|
ASC
& Hosp
|
Bundling
or CCI Modifiers
|
|
-25
|
Significant
separately identifiable E/M service
|
GP&
E/M
Only
|
Þ
|
E/M
|
|
|
|
|
|
ASC
& Hosp
|
|
-26
|
Professional
component
|
CCI
|
Ü
|
|
|
Surgery
|
Radiology
|
Path
& Lab
|
Medicine
|
|
|
-59
|
Distinct
procedural service
|
CCI
|
Þ
|
|
Anesthesia
|
Surgery
|
Radiology
|
Path
& Lab
|
Medicine
|
ASC
& Hosp
|
|
-25
|
Significant
separately identifiable E/M service
|
GP&
E/M
Only &
CCI
|
Þ
|
E/M
|
|
|
|
|
|
ASC
& Hosp
|
Evaluation
& Management Only Modifiers
|
|
-21
|
Prolonged
E/M services
|
E/M
Only
|
Ú
|
|
|
|
|
|
|
|
|
-24
|
Unrelated
E/M service by the same physician during a postop
period
|
GP
&
E/M
Only
|
Þ
|
E/M
|
|
|
|
|
|
|
|
-25
|
Significant
separately identifiable E/M service
|
GP&
E/M
Only
|
Þ
|
E/M
|
|
|
|
|
|
ASC
& Hosp
|
|
-57
|
Decision
for surgery
|
GP
&
E/M
Only
|
Þ
|
E/M
|
|
|
|
|
Medicine
|
|
|
-27
|
Multiple
outpatient hospital E/M encounters on the same
date
|
E/M
Only
|
Þ
|
|
|
|
|
|
|
ASC
& Hosp
|
Number of Surgeons
Modifiers
|
|
-62
|
Two
surgeons
|
#
|
Ü
|
|
|
Surgery
|
Radiology
|
|
|
|
|
-66
|
Surgical
Team
|
#
|
Ü
|
|
|
Surgery
|
|
|
|
|
|
-80
|
Assistant
surgeon
|
#
|
Ü
|
|
|
Surgery
|
Radiology
|
|
|
|
|
-81
|
Minimum
assistant surgeon
|
#
|
Ü
|
|
|
Surgery
|
|
|
|
|
|
-82
|
Assistant
surgeon (when a qualified resident is not
available)
|
#
|
Ü
|
|
|
Surgery
|
|
|
|
|
Other Modifiers
|
|
-22
|
Unusual
procedural services
|
Oth
|
Û
|
|
Anesthesia
|
Surgery
|
Radiology
|
Path
& Lab
|
Medicine
|
|
|
-23
|
Unusual
anesthesia
|
Oth
|
Þ
|
|
Anesthesia
|
|
|
|
|
|
|
-32
|
Mandated
services
|
Oth
|
Þ,
Ú
|
E/M
|
Anesthesia
|
Surgery
|
Radiology
|
Path
& Lab
|
Medicine
|
|
|
-47
|
Anesthesia
by surgeon
|
Oth
|
Û
|
|
Anesthesia
|
Surgery
|
|
|
|
|
|
-50
|
Bilateral
procedure
|
Oth
|
Û
|
|
|
Surgery
|
Radiology
|
|
Medicine
|
ASC
& Hosp
|
|
-51
|
Multiple
procedures
|
Oth
|
Ü
|
|
Anesthesia
|
Surgery
|
Radiology
|
|
Medicine
|
|
|
-52
|
Reduced
services
|
Oth
|
Ü
|
E/M
|
|
Surgery
|
Radiology
|
Path
& Lab
|
Medicine
|
ASC
& Hosp
|
|
-53
|
Discontinued
procedure
|
Oth
|
Ü
|
|
Anesthesia
|
Surgery
|
Radiology
|
Path
& Lab
|
Medicine
|
|
|
-73
|
Discontinued
outpatient hospital/ASC procedure prior to
anesthesia
|
Oth
|
Ü
|
|
|
|
|
|
|
ASC
& Hosp
|
|
-74
|
Discontinued
outpatient hospital/ASC procedure after anesthesia
|
Oth
|
Ü
|
|
|
|
|
|
|
ASC
& Hosp
|
|
-90
|
Reference
(outside) laboratory
|
Oth
|
Ú
|
|
|
|
|
Path
& Lab
|
|
|
|
-91
|
Repeat
clinical diagnostic laboratory test
|
Oth
|
Þ
|
|
|
|
|
Path
& Lab
|
|
ASC
& Hosp
|
|
-99
|
Multiple
modifiers
|
Oth
|
Ú
|
|
|
Surgery
|
Radiology
|
|
Medicine
|
|
| |
|
|
|
|
|
|
|
|
|
|
|