Modifiers

Industry-standard modifiers are often used with procedure codes to clarify the circumstances under which medical services were performed. Modifiers allow the reporting physician to indicate that a service or procedure has been altered by some specific circumstance, but has not been changed in definition or code.

Providers may use modifiers to indicate one of the following:

  • A service or procedure has both a professional and technical component
  • A service or procedure was performed by more than one physician and/or in more than one location
  • A service or procedure has been increased or reduced
  • Only part of a service, an adjunctive service or a bilateral service, was performed
  • A service or procedure was provided more than once
  • Unusual events occurred during the service
  • A procedure was terminated prior to completion

Providers should use applicable modifiers that fit the description of the service and the claim will be processed accordingly. The CPT and HCPCS publications contain lists of modifiers available for describing services.