CPT
Modifier : 22
Description :
Increased Procedural Services: When the work required to provide a service is substantially
is greater than typically required, it may be identified by adding CPT modifier 22 to the usual
procedure code. Documentation must support the substantial additional work and the reason for
the additional work (i.e., increased intensity, time, technical difficulty of procedure, severity
of patient’s condition, physical and mental effort required).
Note: This modifier should not be appended to an E/M service. It should only be
reported with procedure codes that have a global period of 0, 10, or 90 days.
CPT Modifier : 26
Description :Professional Component: Certain procedures are a combination of a physician component
and a technical component. When the physician component is reported separately, the service
may be identified by adding the CPT modifier 26 to the usual procedure number. This modifier
must be reported in the fi rst modifier field.
CPT Modifier : 32
Description :Mandated Services: Services related to mandated consultation and/or related services (e.g.,
third-party payer governmental, legislative or regulatory requirement) may be identifi ed by
adding CPT modifier 32 to the basic procedure.
CPT Modifier : 52
Description :Reduced Services: Under certain circumstances a service or procedure is partially reduced
or eliminated at the physician’s discretion. Under these circumstances the service provided
can be identified by its usual procedure number and the addition of the CPT modifi er 52,
signifying that the service is reduced. This provides a means of reporting reduced services
without disturbing the identification of the basic service.
CPT modifier 52 is used for “unusual (reduced) circumstances.” It designates that the service
performed was significantly less than usually required. In many instances, attachments,
medical records, etc. are not required to be sent in if an explanation for the reduction is in the
narrative field of the claim. For example, submit “one view only” in the narrative when only
one view of a two view study is performed. Similarly “right side only” may be submitted when
a procedure code that is bilateral by definition is not performed bilaterally. When additional
information to support the use of the 52 CPT modifier cannot be contained in the narrative
of the claim, additional documentation may be submitted.
CPT Modifier : 76
Description :Repeat Procedure or Service by Same Physician: It may be necessary to indicate that a
procedure or service was repeated subsequent to the original procedure or service. This
circumstance may be reported by adding the CPT modifier 76 to the repeated procedure or
service.
CPT Modifier : 77
Description :Repeat Procedure by Another Physician: The physician may need to indicate that a basic
procedure or service performed by another physician had to be repeated. This situation may
be reported by adding CPT modifier 77 to the repeated procedure or service.
CPT Modifier : 90
Description :Reference (Outside) Laboratory: When laboratory procedures are performed by a party other
than the treating or reporting physician, the procedure may be identified by adding the CPT
modifier 90 to the usual procedure number.
For the Medicare program, this modifier is used by independent clinical laboratories
when referring tests to a reference laboratory for analysis.
CPT Modifier : 91
Description :Repeat Clinical Diagnostic Laboratory Test: In the same course of treatment of the patient,
it may be necessary to repeat the same laboratory test on the same day to obtain subsequent
(multiple) test results. Under these circumstances, the laboratory test performed can be
identified by its usual procedure number and the addition of the CPT modifi er 91.
Note: This modifier may not be used when tests are rerun to confirm initial results;
due to testing problems with specimens or equipment; or for any other reason when
a normal, one-time, reportable result is all that is required. This modifier may not be
used when other codes describe a series of test results (e.g., glucose tolerance tests,
evocative/suppression testing). This modifier may only be used for laboratory tests
performed more than once on the same day for the same patient.
CPT Modifier :92
Description :Alternative Laboratory Platform Testing: When laboratory testing is being performed
using a kit or transportable instrument that wholly or in part consists of a single use,
disposable analytical chamber, the service may be identified by adding CPT modifi er 92
to the usual laboratory procedure code (HIV testing CPT codes 86701-86703). The test
does not require permanent dedicated space; hence by its design it may be hand carried or
transported to the vicinity of the patient for immediate testing at that site, although location
of the testing is not in itself determinative of the use of this modifier.
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