Tuesday, November 16, 2010

If claim goes with modifier 22, how much payment will get?

Modifier 22: Denotes an unusual procedural service. Should only be submitted on surgical procedure codes along with supporting documentation to justify the unusual service:

* If documentation supports sufficient difficulty/complexity to warrant additional payment for a procedure submitted with Modifier -22, then 25% of the eligible amount is allowed as an additional payment.
*  Otherwise, no additional payment is allowed.
*  A provider is allowed one appeal if the initial request for recognition of Modifier - 22 is denied.

Modifier 25: Denotes a significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service. Should only be submitted on an evaluation and management code, and medical records should reflect the significant, separately identifiable service.

1 comment:

Most read cpt modifiers