What Are CPT Modifiers?

Current Procedural Terminology (CPT) are five-digit numbers (also known as modifiers) and are primarily used in office and outpatient settings. They are a more in-depth look at medical coding. These codes are primary way you bill your patients. The more precise the medical record, the more accurate your billing.

CPT is created with two-digit codes, related to the CPT, to give a deeper explanation of the evaluation and management of your patients. They include any procedures that take place during a patient's office visit. Here are the commonly used CPT modifiers.

Modifier 22 - Increased Procedural Service

This is exclusively used if there is a need for more treatment than originally planned. There's an increased amount of work during a procedure. Patients will often need further documentation of services provided before making their payment.

Modifier 25 - Significant, Separate Identifiable Service

This occurs if there are two identifiable diagnoses during a visit. When a separate, but significant, evaluation and management (E/M) service is conducting the same day as another procedure by the same physician. There may be cases where one diagnosis is required, but usually two are required for this modifier.

Modifier 26 - Professional Component

This is when service is provided at a different location or from a different physician. This can include x-rays, blood work, or other procedures that are done at a different practice than where your patient is treated.

Modifier 50 - Bilateral Procedure

This happens during the same operative session by the same physician in either separate operative areas (hands, feet, legs, arms, ears) or in the same operative area (nose, eyes, breasts). However, it's important to confirm that a bilateral procedure isn't already mentioned in the original CPT code.

Modifier 51 - Multiple Procedures

This is used if multiple procedures were performed on the same session by the same by the same provider. Normally, the most expensive procedure will be listed first, followed by the other procedures done.

Modifier 52 - Reduced Services

You use this modifier when a physician chooses to stop providing services, treatment, or a procedure to a patient. It can be attached when the pause of service is necessary due to a patient failing to cooperate, another similar instance occurs, or the procedure is not completed.

Modifier 59 - Distinct Procedural Service

This is used when two or more procedures are completed on the same day by the same physician but for different reasons. The documentation must state each CPT is necessary due to a separate visit on the same day, an unrelated injury, a different site, or a different organ system was involved.

These are the more common CPT modifiers used. They provide distinct and specific codes so you can accurately and efficiently charge your patients. They ensure that your patients are being billed for the exact procedures and services they received while ensuring your practice is reimbursed for their services.