Cpt Modifiers 2011

Front 1

Modifier -22

Back 1

Increased Procedural Services

(When the work required to provide a service is substantially greater than typically required. Documentation must support the use of this modifier. This modifier should NOT be added to an E/M code.)

Front 2

Modifier -23

Back 2

Unusual Anesthesia

(Occasionally a procedure which usually requires either no anesthesia or local anesthesia must be done under general anesthesia. Add modifier to the procedure code of the basic service.)

Front 3

Modifier -24

Back 3

Unrelated Evaluation and Management Service by the Same Physician During Postoperative Period.

(The physician may need to indicate that an E/M service was performed during a postoperative period for a reason(s) unrelated to the original procedure. Apply to the E/M code.)

Front 4

Modifier -25

Back 4

Significant, Separately Identifiable Evaluation and Managment Service by the Same Physician on the Same Day of the Procedure or Service.

(Append to E/M code only)

Front 5

Modifier - 26

Back 5

Professional Component

(Certain procedures are a combination of a physician component and a technical component. When the physician component is reported separately add this modifier to the procedure code.)

Front 6

Modifier -32

Back 6

Mandated Services

(Services related to mandated consultation and/or related services (e.g. third party payer). Add to a procedure code.)

Front 7

Modifier -47

Back 7

Anesthesia by Surgeon

(Regional or general anesthesia provided by the surgeon may be reported by adding this modifier to the basic service. (This does not include local anesthesia.) This modifier would not be used for the anesthesia services.)

Front 8

Modifier -50

Back 8

Bilateral Procedure

(Unless otherwise identified in the listings, bilateral procedurs that are performed at the same session, should be identified by add this modifier to the appropriate 5 digit code.)

Front 9

Modifier -51

Back 9

Multiple Procedures

(When multiple procedures other than E/M services, Physical Med and Rehab services or provision of supplies(e.g. vaccines) the primary procedure may be reported as listed. Append modifier 51 to the additional procedure or service. Do not add 51 to "add on" codes.)

Front 10

Modifier -52

Back 10

Reduced Services

(Certain circumstances a service or procedure is partiall reduced or eliminated at the physicians discretion. Add this modifier to the procedure code.)

Front 11

Modifier -53

Back 11

Discontinued Procedure

(Certain circumstances warrent terminating a surgical or diagnostic procedure. It may be necessary to indicate that a surgical or dagnostic procedure was started by discontinues. Add this modifier to the procedure or diagnostic code.)

Front 12

Modifier -54

Back 12

Surgical Care Only

(When 1 physician performs a sugical procedure and another provides preoperative and/or postoperative management, surgical services may be added to the procedure code.)

Front 13

Modifier -55

Back 13

Postoperative Management Only

(When 1 physician performed the postoperative management and another physician performed the surgical procedure, the post op component may be identified by adding this modifier to the procedure code.)

Front 14

Modifier -56

Back 14

Preoperative Management Only

(When 1 physician performed the preop care and eval and another physician performed the surgical procedure the pre op component may be identified by adding this modifier the procedure code)

Front 15

Modifier - 57

Back 15

Decision for Surgery

(An E/M service that resulted in the initial decision to perform the surgery may be identified by adding this modifier to the E/M code.)

Front 16

Modifier -58

Back 16

Staged or Related Procedure or Service by the Same Physician During the Postoperative Period

(It may be necessary to indicate the performance of a procedure or service during the post op period was a) planned (staged); b) more extensive than orginal procedure c) for therapy following a surgical procedure. Add this modifier to the staged or related procedure code.)

Front 17

Modifier -59

Back 17

Distinct Procedural Service

(Under certain circumstances it may be necessary to indicate a procedure or sercie was distinct or indipenent from other non-E/M services performed on the same day. Add this modifier to services not normally performed together but are appropriate under the circumstances.)

Front 18

Modifier -62

Back 18

Two Surgeons

(When 2 surgeons work together as primary surgeons performing distinct part(s) of a procedure, each surgeon should report the distinct operative work adding this modifier.)

Front 19

Modifier -63

Back 19

Procedure Performed on Infants less than 4 kg.

(Procedures performed on neonates and infants ip to a present body weight of 4 kg my involve significantly increased complexity and physician work commonly associated with these patients. Add this modifier to the procedure code.)

Front 20

Modifier -66

Back 20

Surgical Team

Under certain circumstances highly complex procedures (requiring several physicians, often different specialties, plus specially trained personnel are carried out under "surgical team". Add modifier to the procedure code that coincides with the service provided.)

Front 21

Modifier -76

Back 21

Repeat Procedure or Service by Same Physician or Other Qualified Health Care Professional

(It may be necessary to indicate a procedure or service was repeated by the same physician or other heath professional subsequent to the original procedure, add the modifier to the repeated procedure code.)

Front 22

Modifier -77

Back 22

Repeat Procedure or Service by Another Physician or Other Qualified Health Care Professional

(It may be necessary to indicate that a basic procedure or service was repeated by the same physician or other heath professional subsequent to the original procedure, add the modifier to the repeated procedure code.)

Front 23

Modifier -78

Back 23

Unplanned Return to the Operating/Procedure Room by the Same Physician or Other Qualified Health Care Professional Following Initial Procedure for a Related Procedure During the Postoperative Period

(It may be necessary to indicate another procedure was performed during the postoperative period of the initial procedure. When it is related to the first and requires the OR/Procedure room report by adding this modifier to the related procedure.)

Front 24

Modifier -79

Back 24

Unrelated Procedure or service by the Same Physician During the Postoperative Period

(The physiican may need to idicate the performance of a procedure or sercie during the postop period was unrelated to the original procedure. Add this modifier to the procedure code.)

Front 25

Modifier -80

Back 25

Assistant Surgeon

(Surgical assistant services may be identified by adding this modifier to the same procedure code the surgeon used.)

Front 26

Modifier -81

Back 26

Minimum Assitant Surgeon

Minimum surfical assistan services are identified by adding this modifier toe the same procedure code the surgeon used.)

Front 27

Modifier -82

Back 27

Assistant Surgeon (when qualified resident surgeon not available).

(The unavailability of a qualified resident surgeon is a prerequisite for use of this modifier append to the same procedure code the surgeon uses.)

Front 28

Modifier -90

Back 28

Reference (Outside) Laboratory

(When laboratory procedures are performed by a party other than the treating or reporting physician the procedure my be identified by add this modifier to the lab code.)

Front 29

Modifier -91

Back 29

Repeat Clinical Diagnostic Laboratory Test

In the course of treatment of the patient it may be necessary to repeat the same laboratory test on the same day to obtain subsequent test results. Add this modifier to subsequent lab codes.)

Front 30

Modifier -92

Back 30

Alternate Laboratory Platform Testing

(When laboratory testing is being performed using a kit or transportable instrument that wholly or in part consists of a single use, disposable analytical chamber the service may be identified by adding this modifier to the usual laboratory procedure code (HIV testing 86701-86703).)

Front 31

Modifier -99

Back 31

Multiple Modifiers

(Under certain circumstances 2 or more modifiers may be necessary to completely delineate a service. Add this modifier to the basic procedure and other applicable modifiers may be listed as part of the description of the service.)