Modifiers:

Two digits number. It can be numeric, Alphanumeric or

Alphabetic. Always use CPT codes and some time with
HCPCS.

22: Increased Procedural Time. Physicians devote extra

time due to difficulty or complications of procedure.
44905-22. This modifier is only used with Surgical CPT
Codes.

Global Surgical Package (Warranty Period): 0 Days or

10 Days (minor Surgery) or 90 Days (Major Surgery)
(Warranty Period after surgery)

24, 25 and 57 modifiers only Used with E/M service:

here E/M is Evaluation and Management.

25 Modifier: If a Physician performed E/M service and

minor surgery on the same day. Surgery should be
different from the reason for E/M service. In that case
we need to append modifier 25 with E/M service code.
To report E/M and surgery together on the same day
E/M service should be separately identifiable. E/M and
surgery date should be the same.
Patient Arrived for E/M service and Physician also
performed minor Surgery on Same Day. Surgery should
be unrelated to the problem for which patient arrived.

Global Period of Surgery (0 days or 10 Days)- Minor

Surgery.

In this scenario use modifier 25 with E/M CPT Code

Example1: Same day

Date: 04/02/2020
99213-25 (E/M)
33210- (Surgery with global period of 10 days)

Example 2: surgery performed next day

04/02/2020
99213 (No need to add modifier 25)
04/03/2020
33210

Never use 25 modifiers if patient is in Global period

57 Modifier: If E/M service and Major Surgery performed
on either same day or surgery performed next day to
E/M in that case we need to use 57 modifiers with E/M
service. 57 modifiers also known as decision for surgery.

Global Period of Surgery (90 Days)- Major Surgery. Surgery

can be performed on same day of E/M or One day later of E/M
service. In this scenario use modifier 57 with E/M. E/M Service
always need to perform prior to the surgery in case of 25 and
57 modifier.
Example 1: Same day
CPT Code.
Date: 04/02/2020
99213-57
33208 (global period is 90 days)

Example 2: Surgery performed next day

Date:
04/01/2020
99213-57
04/02/2020
33208

Example 3: Surgery performed after two days

Date:
04/01/2020
99213
04/03/2020
33208

Never use 57 modifiers if patient is in Global period

Modifier 24: Use 24 modifier with E/M service performed
during global period for unrelated to previous surgery.
Surgery already performed in past

Surgery already performed in past and patient is in

Global period

Patients already underwent Surgery in the past and now

in the Global Period. Patient arrived for E/M service
E/M related to Previous E/M unrelated to
Surgery Previous surgery
Left hip arthroplasty Left hip arthroplasty
performed performed
now came with Left hip now came with
Pain Abdominal Pain
In This case use
In this case use CPT code modifier 24 with E/M
99024 Service i.e., 99202-
which has Zero Dollar 99205, 99212-99215
Value etc.
78 Modifier: Related surgery performed during Global
Period. (Unplanned Surgery)

79 Modifier: Unrelated Surgery Performed during Global

Period

78 Modifier 79 Modifier
Related Surgery Performed Unrelated Surgery Performed during
during Global Period Global Period
Pacemaker Performed in
Past and during Global Pacemaker Performed in Past and
Period Patient get infection during Global
and physician removed and Period Patient underwent PTCA
implant new Pacemaker (Percutaneous Transluminal
Use 78 Modifier with Angioplasty)
Surgery code 79 Modifier with PTCA

26 Modifier: Professional Component

TC: Technical Component
Global Radiology Billing: No 26 or TC modifier

Radiologist Own Radiologist only Hospital Performed

 Make report of
Office/Clinic and the patient but Radiology procedure
Make Report of not own clinic or but did not make
the patient hospital report
No 26 or TC In this case use In This Case use TC
modifier Required 26 Modifier with modifier with
Global Billing Radiology Only own Hospital or
Report office
71045 (Chest X- And Machine
ray) 71045-26 71045-TC

Do not choose an option which contains a TC modifier in

your CPC exam.

50 Modifier: Bilateral. Both left and right. Never use 50

modifiers if Bilateral is already written in CPT code.

73130-26-50 (X-ray hand 3 views bilateral performed in

hospital and need code for physician)
73130-50 (X-ray hand 3 views bilateral performed in
clinic)

LT- Left
RT-Right

73130-LT
73130-RT
Or
73130-50

51 Modifier: More than one procedure performed at the

same session by the same provider • Not used on E/M
services, Physical Medicine or Rehabilitation Services,
the provision of supplies such as vaccines or codes
designated as ‘add-on’ codes. Example: An orthopedic
surgeon performs a closed treatment of a femoral shaft
fracture on the left leg and a closed treatment of a right
knee dislocation during the same operative session. It
would be coded as 27500-LT and 27552-51-RT.
44950-51

52 Modifier: Reduce Service. Physician started the

procedure and left without completing it after getting the
desired result.

53: Discontinued Service: Physician stopped the

procedure due to complications to the patient. Physician
wants to complete it but the patient’s condition is not
allowed to continue the procedure.
For Hospital (CCS)
73- Modifier- Procedure discontinued prior to anesthesia
74- Modifier- Procedure discontinued after anesthesia

58: Stage Procedure (Planned procedure)

if performed procedure is unplanned use 78 modifier.
Physician performed procedure in Stages

59 Modifier: Distinct procedure. Use unbundled services.

Modifier XE Separate Encounter, A Service That Is Distinct Because It Occurred During A Separate
Encounter
Modifier XP Separate Practitioner, A Service That Is Distinct Because It Was Performed By A
Different Practitioner
Modifier XS Separate Structure, A Service That Is Distinct Because It Was Performed On A
Separate Organ/Structure
Modifier XU Unusual Non-Overlapping Service, The Use Of A Service That Is Distinct Because It
Does Not Overlap Usual Components Of The Main Service

62 Modifier: Two Surgeons

– Work together as primary surgeons
– Perform distinct parts of a procedure
– Dictate op report of their distinct part
– Each will submit the same code and append modifier 62

33208-62 for Surgeon A

33208-62 for Surgeon B

63 modifier: Used if patient weight is less than 4 kg

66 Modifier: – Surgical Team
– Highly complex procedures
– Require differently specialties
– Modifier 66 appended to procedures coded by the
surgical team

80 – Assistant Surgeon
– Assistant surgeon present for entire or substantial
portion of the operation
– Reports the same surgical procedure with modifier 80
appended

81 – Minimum Assistant Surgeon

– Circumstances present that require the services of an
asst surgeon for a short time. Minimal assistance.
– Reports the same surgical procedure with modifier 81
appended

82 – Assistant Surgeon (when qualified resident surgeon

not available)
– Used in a teaching hospital that employs residents
– No residents available and another surgeon is used

76 Modifier: Same procedure, Same Day, same

physician
Chest X-ray 1 View at 10 am by Dr. John
Chest X-ray 1 View at 2 pm by Dr. John
71045 (10 am)
71045-76 (2 pm)

77 Modifier: Same procedure, Same Day, Different

physician
Chest X-ray 1 View at 10 am by Dr. John
Chest X-ray 1 View at 2 pm by Dr. Michael
71045—Dr. John
71045-77- Michael

RT Modifier - Right
LT Modifier- Left

FA Modifier - Left hand Thumb

F1 Modifier - Left Hand Index Finger
F2 Modifier - Left hand Middle Finger
F3 Modifier - Left hand Ring Finger
F4 Modifier - Left Hand Little Finger
F5 Modifier- Right hand Thumb
F6 Modifier - Right Hand Index Finger
F7 Modifier- Right hand Middle Finger
F8 Modifier - Right hand Ring Finger
F9 Modifier - Right Hand Little Finger
TA-T9- Toes Modifiers (same as finger modifier)

E1 Modifier- Left Upper Eyelid

E2 Modifier - Left Lower Eyelid
E3 Modifier - Right Upper Eyelid
E4 Modifier - Right Lower Eyelid
(Note if physician performed bilateral procedure means
either both upper eyelid or both lower eyelid in that case
we need to use 50 modifier rather than E1-E4)

Coronary Artery modifier

RC Modifier - Right Coronary Artery
LC Modifier - Left Circumflex
LD Modifier - Left Anterior Descending
RI- Ramus Intermedius

Q6 Modifier - Locum Tennum- We will consider service

as locum tennum if one physician is on Long Leave and
somebody outside from the group sees the patient in
that case, we will use Q6 modifier with E/M.