Saturday, March 6, 2010

CPT modifiers 21, 22 and 26

Medicare Part B modifiers - 26

Professional Component: Certain procedures are a combination of a physician component and a technical component. When the physician component is reported separately, the service may be identified by adding the modifier 26 to the usual procedure number.
Medicare Part B modifiers - 22

Unusual Procedural Services: When the service(s) provided is greater than what is usually required for the listed procedure, indicate this by adding modifier 22 to the procedure code. A report is also required. For services on the physician fee schedule, modifier 22 is applicable only to those procedure codes for which the global surgery concept applies, whether the procedure code is surgical in nature or not. Supportive documentation, e.g., operative reports, progress notes, order sheets, pathology reports, etc., must be submitted with the claim. Note: Modifier 22 will be removed when reported with procedures that do not have a global surgery period of 0, 10, or 90 days.
Medicare Part B modifiers - 21

Prolonged Evaluation and Management Service: When the face-to-face or floor/unit service(s) provided is prolonged or otherwise greater than that usually required for the highest level of evaluation and management service within a given category, it may be identified by adding a modifier to the evaluation and management code number. A report may also be appropriate.

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