Modifiers

Modifier 25 lets you bill a significant, separate E/M visit on the same day as a procedure. Learn the documentation bar, how it differs from modifier 59, and why payers deny it.

Modifier 59 flags a procedure as distinct from another service on the same day so it bypasses an NCCI edit. Learn when it applies, the X-series alternatives, and how to avoid denials.

Modifier 76 reports a repeat procedure by the same physician on the same patient. Learn when it applies, how it differs from modifier 77, and the denials it prevents.

Modifier 77 reports a repeat procedure by a different physician on the same patient. Learn when it applies, how it differs from modifier 76, and the denials it prevents.

Modifier 95 reports a synchronous telehealth visit delivered by real-time audio and video. Learn when it applies, how it differs from modifier 93, and the denials that follow it.

Modifier GN flags a service under an outpatient speech-language pathology plan of care. Learn what it identifies, how it fits the therapy modifiers, and the denials it prevents.

Modifier GO flags a service under an outpatient occupational therapy plan of care. Learn what it identifies, how it fits the therapy-modifier trio, and the denials it prevents.

Modifier GP flags a service under an outpatient physical therapy plan of care. Learn what it identifies, how it pairs with KX and assistant modifiers, and the denials it prevents.

Modifier KX attests that services above the annual therapy threshold are medically necessary. Learn what it certifies, the threshold and review limits, and the denials it prevents.

Modifier XS reports a service distinct because it was performed on a separate organ or structure. Learn when to use it instead of modifier 59 and the denials it prevents.

Modifier XU reports a service distinct because it does not overlap the usual components of the main service. Learn when to use it instead of modifier 59 and the denials it prevents.