- Anesthesia Modifiers
- Appropriate Usage of Modifier 99
- Assistants at Surgery at Teaching Hospitals
- Bundled Services Missing Appropriate Modifiers at Time of Initial Claim Submission
- Clarification for Billing Services on Fingers and Toes Using Modifiers F1-F9, FA, TI-T9 and TA vs. Modifier 50
- Correct Usage of Modifier 79 for Multiple Procedures
- Co-Surgery/Team Surgery/Assistant Surgery Modifiers
- Modifier 25
- Modifier 33
- Modifier 51
- Modifier 52 Claim Submission Billing Reminder
- Modifier 59 and the Subset Modifiers XE, XP, XS, XU - Specific Modifiers for Distinct Procedural Services
- Modifier 90 Reference to Outside Laboratory
- Modifiers Used in CMS-1500 Claim Reporting
- Modifier Usage
- Proper Billing of Surgical Comanagement (Modifiers 54 and 55)
- Proper Use of Modifiers 59 and 91
- Reminder for Submission of Modifier 22
- Repeat Procedures - Modifiers 76 and 77
Bundled Services Missing Appropriate Modifiers at Time of Initial Claim Submission
Accurate coding and reporting of services are critical aspects of proper billing. Services denied based on the NCCI code pair edits or MUEs may not be billed to Medicare beneficiaries; a provider cannot utilize an ABN to seek payment from a Medicare beneficiary. The NCCI tools found on the CMS website (including the “CMS NCCI Coding Edits”) help providers avoid coding and billing errors and subsequent payment denials.
NCCI (also known as CCI) was implemented to promote national correct coding methodologies and to control improper coding leading to inappropriate payment. NCCI code pair edits are automated prepayment edits that prevent improper payment when certain codes are submitted together for Part B-covered services.
Modifiers may be appended to HCPCS/CPT codes only if the clinical circumstances justify the use of the modifier. A modifier should not be appended to a HCPCS/CPT code solely to bypass an NCCI edit if the clinical circumstances do not justify its use. If the Medicare Program imposes restrictions on the use of a modifier, the modifier may only be used to bypass an NCCI edit if the Medicare restrictions are fulfilled.
Modifiers that may be used under appropriate clinical circumstances to bypass an NCCI edit include:
- Anatomic modifiers: E1-E4, FA, F1-F9, TA, T1-T9, LT, RT, LC, LD, RC, LM, RI
- Global surgery modifiers: 24, 25, 57, 58, 78, 79
- Other modifiers: 27, 59, 91, XE, XS, XP, XU
Documentation in the medical record must satisfy the criteria required by any NCCI-associated modifier used.
In addition to code pair edits, the NCCI includes a set of edits known as MUEs. MUEs have a maximum number of UOS allowable under most circumstances for a single HCPCS/CPT code billed by a provider on a date of service for a single beneficiary.
Submit your claims correctly the first time, proper billing and accurate coding saves the provider and Medicare time and money!
Related Content
Revised 9/28/2023