Modifiers tell the payer that a service was altered in some way without changing its definition: for example, modifier 25 for a significant, separately identifiable evaluation and management service on the same day as a procedure, or 59 for a distinct procedural service.
Missing modifiers cause denials; incorrect or overused modifiers can trigger audits.
Related terms
- NCCI edits
- CMS rules that flag code pairs that should not normally be billed together.
- CPT code
- The five-character code set used to report medical procedures and services.
- HCPCS Level II
- Codes for supplies, equipment, drugs and services not covered by CPT.