CPT modifier used for significant, separately identifiable evaluation and management (E/M) service by the same physician on the day of a procedure or other service. The physician may need to indicate that on the day a procedure or service identified by a CPT code was performed, the patient’s condition required a significant, separately identifiable E/M service above and beyond the other service provided or beyond the usual preoperative and postoperative care associated with the procedure that was performed. The E/M service may be prompted by the symptom or condition for which the procedure and/or service was provided. As such, different diagnoses are not required for reporting the E/M service on the same date.

CPT modifier used for the professional component. Certain procedures are a combination of a professional physician component and a technical component. When the professional (physician) component is reported separately, the service may be identified by adding the modifier -26 to the usual procedure number. Use of this modifier may affect reimbursement. The professional component comprises only the professional services performed by the physician during radiologic, laboratory, and other diagnostic procedures. These services include a portion of a test or procedure that the physician does such as interpretation of the results. The technical component includes personnel; materials including usual contrast media and drugs, film, or xerograph; space; equipment; and other facilities but excludes the cost of radioisotopes. When billing for the technical component, use the usual five-digit procedure number with modifier -TC.

CPT modifier used for multiple outpatient hospital E/M encounters on the same date. For hospital outpatient reporting purposes, utilization of hospital resources related to separate and distinct E/M encounters performed in multiple outpatient hospital settings on the same date may be reported by adding the modifier -27 to each appropriate level outpatient and/or emergency department E/M code(s). This modifier provides a means of reporting circumstances involving E/M services provided by physician(s) in more than one (multiple) outpatient hospital setting(s) (e.g., hospital emergency department, clinic). Do not use this modifier for physician reporting of multiple E/M services performed by the same physician on the same date. See evaluation and management (E/M) codes, emergency department , or preventive medicine codes .

CPT modifier used for mandated services. Services related to mandated consultation and/or related services (e.g., PRO, third-party payer, governmental, legislative or regulatory requirement) may be identified by adding the modifier -32 to the basic procedure. The modifier is informational in nature. Do not ask for an adjustment in reimbursement. Monitor reimbursement when using this modifier.

CPT modifier used for anesthesia by surgeon. Regional or general anesthesia provided by the surgeon may be reported by adding the modifier -47 to the basic service (this does not include local anesthesia). This modifier may affect reimbursement, depending on the payer. Modifier -47 would not be used for anesthesia procedures 00100 through 01999.

CPT modifier used for a bilateral procedure. Unless otherwise identified in the listings, bilateral procedures requiring a separate incision performed during the same operative session should be identified by the appropriate five-digit code describing the first procedure. The second (bilateral) procedure is identified by adding modifier -50 to the procedure number. It is important to read each surgical description carefully to look for the word “bilateral.” A bilateral modifier on a unilateral procedure code indicates that the procedure was performed on both sides of a paired organ during the same operative session.

CPT modifier used for multiple procedures. When multiple procedures, other than E/M services, are performed at the same session by the same provider, the primary procedure or service may be reported as listed. The additional procedure(s) or service(s) may be identified by adding the modifier -51 to the additional procedure or service code(s). This modifier should not be appended to designated “add-on” codes (see Appendix E of CPT). Always list the procedure of highest dollar value first.

Symbol used in the procedure code book titled Current Procedural Terminology (CPT) to indicate a procedure code listed is exempt from the use of modifier -51 but have not been designated as CPT add-on procedures/services. A summary of five-digit procedural codes exempt from modifier -51 are shown in Appendix E in CPT.

CPT modifier for reduced services. Under certain circumstances a service or procedure is partially reduced or eliminated at the physician’s election. Under these circumstances the service provided can be identified by its usual procedure number and the addition of the modifier -52, signifying that the service is reduced. This provides a means of reporting reduced services without disturbing the identification of the basic service. This modifier affects reimbursement, but there will be no effect on the physician’s fee profile in the computer data. It is not necessary to attach a report to the claim when using this modifier because it indicates a reduced fee. When a physician performs a procedure but does not charge for the service such as a postoperative follow-up visit that is included in a global service, remember to use code 99024. Some physicians prefer to bill the insurance carrier the full amount and accept what the carrier pays as payment in full. In such cases, a modifier would not be used. If only part of a procedure is performed and the physician feels a reduction in the service is warranted, to develop a reduced fee, try calculating the reduced service by time. Calculate the amount (cost) per minute of the complete procedure by dividing the amount (cost) by the usual time it takes to complete the procedure. To determine how long the reduced procedure took, multiply the amount (cost) per minute by the time it took to do the reduced procedure.

CPT modifier used for discontinued procedure. Under certain circumstances, the physician may elect to terminate a surgical or diagnostic procedure. Due to extenuating circumstances or those that threaten the well-being of the patient, it may be necessary to indicate that a surgical or diagnostic procedure was started but discontinued. This circumstance may be reported by adding the modifier -53 to the code for the discontinued procedure. This modifier is not used to report the elective cancellation of a procedure before the patient’s anesthesia induction and/or surgical preparation in the operating suite. For outpatient hospital/ambulatory surgery center (ACS), see modifier -73 and modifier -74 .