Monday, May 31, 2010

HCPCS LEVEL II MODIFIERS



The following HCPCS level II modifiers are added, as appropriate, primarily to codes for procedures performed on paired organs (e.g., eyelids, fingers, toes, or arteries, etc.). These modifiers are used to prevent erroneous denials when duplicate HCPCS codes are billed to report separate procedures performed on  different anatomical sites or different sides of the body.

Guidelines for Level II Modifiers

• When a modifier is needed, the most specific modifier should be used first.

EXAMPLE: Use modifier -E1 for the upper left eyelid, instead of modifier LT.
• If more than one level II modifier applies, repeat the HCPCS code on another line with the appropriate level II modifier.
EXAMPLE: Code 26010 (drainage of finger abscess; simple) done on the left hand thumb and second finger would be billed: 26010-FA (one line) and 26010-F1 (separate line).
• Modifiers -LT and-RT
- Apply to codes that identify procedures which can be performed on a contralateral anatomic sites (joints, bones) or on paired organs, extremities and, e.g., ears, eyes, nasal passages kidneys, lungs, ureters and ovaries
- Required when the procedure is performed on only one side, to identify the side operated upon
- Modifiers –LT and –RT should not be used in place of or in conjunction with modifier –50.

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