Correct Modifiers Protect Payments

If you perform more than one procedure in a day, add a modifier to show it was separate. Without the modifier, a claim could be denied if another related service appears for that date.

Do This

Use modifiers to show services are separate:

• Different sessions
• Different procedures or surgeries
• Different body parts or organ system
• Separate incisions or excisions
• Non-contiguous lesions in different regions
• Separate injuries not usually treated the same day
• Second injections when needed for two sites or a separate visit

Keep in Mind

Check for claim edits when related procedures are billed including the following:

• Duplicate claims
• National Correct Coding Initiative edits
• Mutually exclusive procedures
• Same or similar procedures done recently
• Unbundled or incidental procedures

See our payment policies for details on using the right modifiers.