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Modifiers

Modifiers

GA modifier

3 Tips to Comply With UHC’s New GA Modifier Policy

Anyone who’s ever filled out an advance beneficiary notice (ABN) for a Medicare patient knows what the GA modifier is. This modifier tells Medicare payers that an ABN is on file for a service that the insurer doesn’t cover. And as of February 1st, it will also do the same for UnitedHealthcare (UHC) commercial plans. […]
Published Date: January 27, 2025
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RT and LT modifiers

Real-World Examples Guide When to Use RT and LT Modifiers

If you’ve ever coded a patient chart, you know about the LT (Left side) and RT (Right side) modifiers. Together, the RT and LT modifiers are used to show laterality — in other words, they describe which side of the body was addressed during a procedure or surgery, or if supplies are being prescribed. Check […]
Published Date: January 2, 2024
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Modifier 25

3 Modifier 25 Best Practices to Keep Your E/M Pay Flowing

Every minor procedure your providers perform includes an inherent evaluation and management (E/​M) portion factored into the reimbursement for it. But when you go beyond that cursory E/​M work, you should be able to collect for the extra time your provider spends — and that’s where modifier 25 comes in. Although modifier 25 represents a […]
Published Date: November 28, 2023
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CPT modifiers

3 Ways Payers Are Monitoring Your Use of CPT Modifiers

Without CPT modifiers, many coders would struggle to submit accurate claims to payers. Why? Because modifiers allow you to provide insurers with more information about a service or supply, without changing the meaning of the code they’re modifying. In many cases, modifiers can be the difference between a denial and a claim approval. Coders have […]
Published Date: October 23, 2023
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Modifier 59

4 Uses of Modifier 59 That Are Appropriate (And 2 That Aren’t)

Whether or not you have a solid understanding of the National Correct Coding Initiative (NCCI) edits, you are likely very familiar with modifier 59 and the X modifiers, which allow you to report two procedures at the same time. What many practices don’t know, however, is that payers are waiting for you to misuse these […]
Published Date: July 26, 2023
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Modifier 25

Cigna Delays Plan Requiring Medical Records With Modifier 25

UPDATE: Cigna has delayed the requirement described below, and it will no longer take effect on May 25. The company has not yet indicated when it will go into place, so keep an eye on the Healthcare Training Leader website for more information as this story develops. When you perform a minor procedure along with […]
Published Date: May 23, 2023
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Modifier 58

Modifier 58 vs 78: Boost Pay-up for Post-Op Procedures

Using modifier 58 to code post-operative procedures can prevent payer denials and decreased reimbursement for services – but you must use it correctly. When coding post-op procedures, most problems occur because of the similarities between two key modifiers: Modifier 58 – staged or related procedure or service by the same physician during the postoperative period, […]
Published Date: March 10, 2022
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Billing modifier 62

Step-by-Step Tips to Head Off Modifier 62 Overpayments

The January 2021 updated OIG Work Plan makes it clear that the Office of the Inspector General (OIG) is paying attention to surgical modifier 62. The Work Plan states.billing modifier 62. “…we plan to audit a sample of claim line items specifically where different physicians billed for the same co-surgery procedure code, for the same […]
Published Date: March 17, 2021
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Using modifier 25

Key to Using Modifier 25? Separate History and Exam

With the new 2021 E/​M guidelines in effect, payers and auditors have made it clear that they’ll be closely scrutinizing E/​M claims more than usual—this includes the modifiers appended to them as well. One of the murkiest modifiers continues to be 25 (a significant, separately identifiable evaluation and management service by the same physician or […]
Published Date: March 11, 2021
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Shoulder unbundling errors

Head Off Revenue Losses Due to Shoulder Unbundling Errors

You don’t want to miss billing an allowed shoulder procedure and leave thousands of dollars on the table. But it’s imperative that you avoid shoulder unbundling errors – or your repeated billing of included charges can land you with costly denials, and accusations of abuse or fraud. It’s critical that you know when to legally […]
Published Date: November 2, 2020
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