Top 20 – Most commonly used Modifier

Modifier Description 22 Increased Procedural Service: When the work required to provide a service is substantially greater than typically required, it may be identified by adding modifier 22 to the usual procedure code. Documentation must support the substantial...

CPT CODE 80047, 80048

Basic Metabolic Panel (Calcium, total), 80048 CPT coding guidelines indicate that a Basic Metabolic Panel (Calcium, total), CPT code 80048 should not be reported in conjunction with 80053. If a submission includes CPT 80048 and CPT 80053, only CPT 80053 will be...

Modifier “-91 with how to use example

Definition – The “-91” modifier is used to indicate a repeat laboratory procedural service on the same day to obtain subsequent reportable test values. The physician may need to indicate that a lab procedure or service was distinct or separate from other lab...

Handling Incomplete or Invalid Submissions

The A/B MACs (A) should take the following actions upon receipt of incomplete or invalid submissions: • If a required data element is not accurately entered in the appropriate field, RTP the submission to the provider of service. • If a not required data element is...