Modifiers

If you have ever had a discussion with medical billers, you will know that most of them agree on one thing: that billing of laboratory tests is one of the most complex. Why? Because laboratory testing is needed in almost all medical specialties. Hence, a large pool of CPT codes, ICD-10 codes, and modifiers must […]

Receiving denials for incorrectly using modifier 90? You are not the only one! Many healthcare providers experience this problem when they submit claims for services referred to an outside laboratory. The reason? Ignoring payer guidelines! As a result, their administrative staff face extra pressure and have to spend extra time correcting errors and chasing denials.

Healthcare is a heavily regulated industry, and if you are a Medicare-approved provider, you must be familiar with the repercussions of incorrect billing. Filing Medicare claims is hard enough, but what if you made a mistake or HAD TO render an uncovered service because the patient demanded it?  Should you accept your error or risk

Surgical procedures don’t always go as planned. How many times have you required help in the middle of an operation due to a complication? This might be routine for healthcare providers, but we know that there is one thing you all struggle with: accurately reporting the assistant surgeon’s role! Did you know that you cannot

For 72% of U.S. physicians, implementing telehealth services is the easy part. The real challenge is billing for them. Are you also looking for a way to file accurate claims for these services? We might have the perfect solution for you — Modifier 95! Introduced in 2017 by the American Medical Association (AMA), this CPT

Do you report the involvement of an assistant surgeon? If not, you could be missing out on rightful reimbursements! Many practices fail to report surgical assistance properly. The primary reason? Limited understanding of modifiers!   That’s where the ‘Assistant at Surgery’ modifiers come in, highlighting the involvement of a physician or other qualified professional in a

Federal and state health departments usually supply influenza, pneumococcal, COVID-19, and hepatitis B vaccines for free to healthcare providers to prevent the spread of contagious diseases through various programs like VFC.  According to the U.S. Centers for Disease Control and Prevention’s ‘Vaccination Trends’ for 2024-25, nearly half of the adult population in the USA is

What do you know about laterality modifiers? You cannot skip these modifiers if you have performed a procedure on one of the paired body parts, such as eyes, ears, arms, legs, and even organs. We all know that medical billing isn’t just about submitting timely claims. It is also about specifying everything. RT and LT

Have you ever billed an anesthesia service that required more effort? Most minor procedures typically need local anesthesia. However, some cases don’t go as planned and end up requiring general anesthesia services. So, how do you handle this unusual complication? The answer is obviously through a modifier. Modifier 23 is often applied in such cases.

How do you inform a payer about the patient being fully responsible for all the charges? Through the GY modifier! You can communicate any situation with a specific modifier. These codes are the key to avoiding complicated issues or conflicts. So, what exactly is the role of modifier GY? This two-character code indicates that a