Coding and Billing Guidelines | Provider (2024)

The use of modifiers is an important component to coding and billing for services. A modifier is a two-digit character (numeric, alpha numeric, or alpha) designed to provide additional information needed to process a claim or increase or decrease reimbursem*nt. Modifiers allow a provider to identify that a special circ*mstance has altered a service, but that the basic procedure code description has not changed. Appropriately document the patient’s medical record or chart to support the use of any modifier.

In certain circ*mstances, multiple modifiers may be necessary to completely describe a service. Our payment system recognizes multiple modifiers to allow you to bill up to four separate modifiers per claim line.

When more than 4 modifiers are needed for a service, modifier 99-Multiple Modifiers should be used to reflect this situation. Make sure that documentation in the member’s medical record supports all the modifiers submitted.

We process the following modifiers when appended to an appropriate code(s). Where applicable, the provider's fee schedule allowed amount will be adjusted per any percentage noted. Please note this doesn't represent all of the available modifiers but a list of commonly used modifiers: