CPT Modifiers
When each modifier applies — and when it triggers a denial. 25 entries.
Modifier 24 marks an E/M visit during a surgical global period (10 or 90 days) as unrelated to the surgery, so it pays …
Modifier 25: A Significant, Separate E/M Visit on the Same Day as a ProcedureModifier 25 tells the payer an E/M visit on the same day as a minor procedure was significant and separately identifiab…
Modifier 26: Billing Only the Professional Component (the Interpretation)Modifier 26 bills only the professional component of a diagnostic service — the physician's interpretation and written …
Modifier 50: The Same Procedure Done on Both Sides of the BodyModifier 50 reports a bilateral procedure — the same surgery performed on both sides of the body at the same session. M…
Modifier 51: Multiple Procedures Performed at the Same SessionModifier 51 flags second and subsequent procedures performed at the same session by the same provider. Payers rank the …
Modifier 52: A Procedure That Was Deliberately Reduced or Cut ShortModifier 52 reports a service that was partially reduced or eliminated at the provider's discretion — the planned proce…
Modifier 53: A Procedure Stopped Because Continuing Would Endanger the PatientModifier 53 reports a discontinued procedure — the provider started it, then stopped because the patient's well-being w…
Modifier 57: The Visit Where the Decision for Major Surgery Was MadeModifier 57 marks an E/M visit as the one where the decision for major surgery (90-day global) was made, exempting it f…
Modifier 59: A Distinct, Separate Procedure That Normally BundlesModifier 59 identifies a procedure as distinct from another service the same day — different session, site, lesion, or …
Modifier 76: The Same Provider Repeats the Same Procedure the Same DayModifier 76 reports a repeat procedure or service by the same provider on the same day — a second chest X-ray after che…
Modifier 77: A Different Provider Repeats the Same Procedure the Same DayModifier 77 reports a repeat procedure by a different provider on the same day the original was performed — a second EK…
Modifier 78: An Unplanned Return to the OR for a Related Problem During the Global PeriodModifier 78 reports an unplanned return to the operating or procedure room during the global period, by the same provid…
Modifier 79: An Unrelated Procedure by the Same Provider During the Global PeriodModifier 79 reports a procedure during a surgical global period that is unrelated to the original operation, performed …
Modifier 91: The Same Lab Test Repeated on the Same Day for New ResultsModifier 91 reports a repeat clinical diagnostic laboratory test on the same day, performed to obtain new, medically ne…
Modifier 95: A Visit Delivered by Real-Time Audio and Video TelehealthModifier 95 identifies a service delivered via synchronous audio-video telehealth. Commercial payers rely on it heavily…
Modifier GA: An ABN Is on File, So the Patient Accepts LiabilityModifier GA tells Medicare a signed Advance Beneficiary Notice (ABN) is on file for a service expected to be denied as …
Modifier GT: The Legacy Telehealth Modifier Most Payers ReplacedModifier GT means "via interactive audio and video telecommunications systems." Medicare retired it from professional c…
Modifier GY: A Service Medicare Never Covers by LawModifier GY marks a service as statutorily excluded from Medicare — not a benefit at all, like hearing aids or most cos…
Modifier GZ: You Expect a Denial and Have No ABN to Protect YouModifier GZ tells Medicare you expect the service to be denied as not reasonable and necessary and you do not have a si…
Modifiers LT and RT: Telling the Payer Which Side of the Body Was TreatedModifiers LT (left) and RT (right) identify which side of the body a procedure was performed on. They are informational…
Modifier TC: Billing Only the Technical Component (the Equipment and Staff)Modifier TC bills only the technical component of a diagnostic service — the equipment, supplies, and technologist time…
Modifier XE: A Distinct Service Because It Happened at a Separate EncounterModifier XE reports a service that is distinct because it occurred during a separate encounter on the same day — a morn…
Modifier XP: A Distinct Service Because a Different Practitioner Performed ItModifier XP reports a service that is distinct because a separate practitioner performed it — two bundled services on t…
Modifier XS: A Distinct Service Because It Was a Separate Organ or StructureModifier XS reports a service that is distinct because it was performed on a separate organ or structure — a different …
Modifier XU: A Distinct Service Because It Does Not Overlap the Main ProcedureModifier XU reports an unusual non-overlapping service — one that does not share the usual components of the main servi…
Want this handled instead of studied?
Our team lives in this material every day. Free billing audit — pay only when you get paid.
