What is a modifier in CPT coding?
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A modifier in CPT (Current Procedural Terminology) coding is a two-character code (numeric or alphanumeric) added to a CPT code to provide extra information about the performed service or procedure. Modifiers clarify circumstances that affect how a service was delivered without changing the actual procedure code.
✅ Purpose of Modifiers:
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Indicate that a service was altered without changing its core definition.
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Help explain why procedures may require additional payment, denial, or adjustment.
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Ensure accurate billing and reimbursement.
🔢 Format:
Modifiers are appended to CPT codes with a hyphen:
The -25 modifier shows that the E/M service was separately identifiable from the procedure and should be reimbursed separately.
✅ Summary:
CPT modifiers provide critical context about procedures, helping ensure precise documentation, correct billing, and proper reimbursement for services rendered under special circumstances.
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