Medical Billing : Categories of Modifiers

Modifiers

A service or procedure can be further described by using 2-digit modifiers. The

Modifier Reference Guide lists Level I (CPT-4), Level II (non-CPT-4 alpha

numeric), and Level III (local) modifiers. Level I and II modifier definitions are

contained in the Healthcare Common Procedure Coding System (HCPCS). Level

III modifiers are defined by the Fiscal Intermediary and may be added only with

prior Centers for Medicare & Medicaid Services (CMS) approval. Modifiers can

be used interchangeably with any code level.

Modifier Categories

When more than one modifier is submitted, the modifiers must be ranked. The

following categories serve as a reference point when ranking modifiers.

A. Pricing Modifiers are considered part of the seven-digit procedure

code by the CMS and are used to determine the reasonable charge or fee

for a service.

*TC *26

* Denotes modifiers which are valid for the first modifier field only.

C. Statistical Modifiers that Affect Pricing are appended to a

procedure code and always cause the reasonable charge or fee for the

code billed to be modified in the same way every time.

*AA *AD AH AJ AS GM

QB *QK QU *QX *QY QZ

SG *UN *UP *UQ *UR *US

21 22 50 51 52 53

54 55 56 62 66 73

74 78 80 82 99

* Denotes modifiers which are valid for the first modifier field only.

E. Statistical / Informational Modifiers are used for documentation

purposes and can affect the processing or payment of the code billed.

*SF

*90

*QT

*QW

* Denotes modifiers which are valid for the first modifier field only.

Medical Billing