Feb 3, 2025 · Modifiers provide additional information to payers to make sure your provider gets paid correctly for services rendered. If appropriate, more than one modifier may be used with a single …

When selecting the appropriate modifier to report on your claim, please ensure that it is valid for the date of service billed. If more than one modifier is needed, list the payment modifiers—those that affect …

Global Surgical Splits (-54/-55): CMS now strictly emphasizes using Modifier 54 (surgeon) and Modifier 55 (post-op provider) for all transfer-of-care scenarios in 90-day global surgeries.

Failure to use a modifier when appropriate may risk lost reimbursement; over-utilizing or using a modifier for payment when not appropriate can put the physician and practice at risk.

Oct 1, 2025 · For example, in the ICD-10-CM Alphabetic Index under the main term Enteritis, “acute” is a nonessential modifier and “chronic” is a subentry. In this case, the nonessential modifier “acute” does …

Jan 1, 2026 · Following are changes pertinent to pediatrics that took effect Jan. 1. Modifier 33 Modifier 33 was developed not only to account for preventive services as defined under the Affordable Care …

This tool provides quick access to detailed descriptions of different modifiers that are appropriate to use with a code including which entities are allowed to bill the modifier.

Mar 14, 2025 · In this guide, we review the CPT Modifier Guidelines with examples such as Modifier 25 and Modifier 59. You will also learn best practices to avoid coding errors, stay compliant, and reduce …

Enter the four required fields and be presented with modifier details such as description, indicators, effective dates, payer information, and more. Note: Existence of a valid procedure/modifier …

Jun 26, 2025 · Learn how modifier codes in medical billing affect reimbursements and help reduce denials with proper usage.