“Modifiers – It’s All About the Money!”  

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

E/M

 

 

 

 

 

 

-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