Mississippi Administrative Code › Title 20 - Labor › Part 2 - Mississippi Workers' Compensation Medical Fee Schedule › MODIFIER AND CODE RULES › Section 20-2-I - MODIFIERS FOR CPT CODES

Current through June 25, 2024
Modifiers augment CPT codes to more accurately describe the
				  circumstances of services provided. When applicable, the circumstances should
				  be identified by a modifier code: a two-digit number placed after the usual
				  procedure code, separated by a hyphen. If more than one modifier is needed,
				  place the multiple modifiers code 99 after the procedure code to indicate that
				  two or more modifiers will follow.
22 Increased Procedural
				  Services
When the work required to provide a service is substantially
				  greater than typically required, it may be identified by adding modifier 22 to
				  the usual procedure code. Documentation must support the substantial additional
				  work and the reason for the additional work (ie, increased intensity, time,
				  technical difficulty of procedure, severity of patient's condition, physical
				  and mental effort required). Note: This modifier should not be appended to an
				  E/M service.
Mississippi guideline: A report explaining the
				  medical necessity of the situation must be submitted with the claim to the
				  payer. By definition, this modifier would be used in unusual circumstances only
				  and is not appropriate to use for billing of routine procedures. Use of this
				  modifier does not guarantee additional reimbursement. When appropriate, the Fee
				  Schedule reimbursement for modifier 22 is one hundred twenty percent (120%) of
				  the maximum allowable reimbursement.
23 Unusual Anesthesia
Occasionally, a procedure, which usually requires either no
				  anesthesia or local anesthesia, because of unusual circumstances must be done
				  under general anesthesia. This circumstance may be reported by adding modifier
				  23 to the procedure code of the basic service.
24 Unrelated Evaluation and Management Services
				  by the Same Physician or Other Qualified Health Care Professional During a
				  Postoperative Period
The physician or other qualified health care professional may
				  need to indicate that an evaluation and management service was performed during
				  a postoperative period for a reason(s) unrelated to the original procedure.
				  This circumstance may be reported by adding modifier 24 to the appropriate
				  level of E/M service.
25 Significant, Separately Identifiable
				  Evaluation and Management Service by the Same Physician or Other Qualified
				  Health Care Professional on the Same Day of the Procedure or Other
				  Service
It may be necessary to indicate that on the day a procedure
				  or service identified by a CPT code was performed, the patient's condition
				  required a significant, separately identifiable E/M service above and beyond
				  the other service provided or beyond the usual preoperative and postoperative
				  care associated with the procedure that was performed. A significant,
				  separately identifiable E/M service is defined or substantiated by
				  documentation that satisfies the relevant criteria for the respective E/M
				  service to be reported (See Evaluation and Management Services Guidelines for
				  instructions on determining level of E/M service). The E/M service may be
				  prompted by the symptom or condition for which the procedure and/or service was
				  provided. As such, different diagnoses are not required for reporting of the
				  E/M services on the same date. This circumstance may be reported by adding
				  modifier 25 to the appropriate level of E/M service. Note: This modifier is not
				  used to report an E/M service that resulted in a decision to perform surgery.
				  See modifier 57. For significant, separately identifiable non-E/M services, see
				  modifier 59.
26 Professional Component
Certain procedures are a combination of a physician or other
				  qualified health care professional component and a technical component. When
				  the physician or other qualified health care professional component is reported
				  separately, the service may be identified by adding modifier 26 to the usual
				  procedure number.
Mississippi guideline: The professional component
				  maximum allowable reimbursement is listed in the PC Amount column of the Fee
				  Schedule.
TC Technical Component (HCPCS
				  Modifier)
Certain procedures are a combination of a professional
				  component and a technical component. When the technical component is reported
				  separately, the service may be identified by adding modifier TC to the usual
				  procedure number. Technical component charges are institutional charges and not
				  billed separately by physicians.
Mississippi guideline: The technical component
				  maximum allowable reimbursement is listed in the TC Amount column of the Fee
				  Schedule.
32 Mandated Services
Services related to mandated consultation and/or related
				  services (eg, third-party payer, governmental, legislative or regulatory
				  requirement) may be identified by adding modifier 32 to the basic procedure.
47 Anesthesia by Surgeon
Regional or general anesthesia provided by the surgeon may be
				  reported by adding modifier 47 to the basic service. (This does not include
				  local anesthesia.) Note: Modifier 47 would not be used as a modifier for the
				  anesthesia procedures.
Mississippi guideline: Reimbursement is made for base
				  units only for anesthesia codes 00100-01999.
50 Bilateral Procedure
Unless otherwise identified in the listings, bilateral
				  procedures that are performed at the same session, should be identified by
				  adding modifier 50 to the appropriate 5 digit code.
Mississippi guideline: This modifier is reimbursed
				  at fifty percent (50%) of the maximum allowable reimbursement, unless the
				  procedure is included in the Pain Management section, where this modifier is
				  reimbursed at twenty-five percent (25%) of the maximum allowable
				  reimbursement.
51 Multiple Procedures
When multiple procedures, other than E/M Services, physical
				  medicine and rehabilitation services, or provision of supplies (eg, vaccines),
				  are performed at the same session by the same individual, the primary procedure
				  or service may be reported as listed. The additional procedure(s) or service(s)
				  may be identified by appending modifier 51 to the additional procedure or
				  service code(s). Note: This modifier should not be appended to designated
				  "add-on" codes (see Appendix D).
Mississippi guideline: This modifier should not be
				  appended to designated "modifier 51 exempt" codes as specified in the Fee
				  Schedule. Services with modifier 51 are reimbursed at fifty percent (50%) of
				  the maximum allowable reimbursement, unless the procedure is included in the
				  Pain Management section, where this modifier is reimbursed at twenty-five
				  percent (25%) of the maximum allowable reimbursement.
52 Reduced Services
Under certain circumstances a service or procedure is
				  partially reduced or eliminated at the discretion of the physician or other
				  qualified health care professional. Under these circumstances the service
				  provided can be identified by its usual procedure number and the addition of
				  modifier 52, signifying that the service is reduced. This provides a means of
				  reporting reduced services without disturbing the identification of the basic
				  service. Note: For hospital outpatient reporting of a previously scheduled
				  procedure/service that is partially reduced or cancelled as a result of
				  extenuating circumstances or those that threaten the well being of the patient
				  prior to or after administration of anesthesia, see modifiers 73 and 74 (see
				  modifiers approved for ASC hospital outpatient use).
53 Discontinued Procedure
Under certain circumstances the physician or other qualified
				  health care professional may elect to terminate a surgical or diagnostic
				  procedure. Due to extenuating circumstances or those that threaten the well
				  being of the patient, it may be necessary to indicate that a surgical or
				  diagnostic procedure was started but discontinued. This circumstance may be
				  reported by adding modifier 53 to the code reported by the individual for the
				  discontinued procedure. Note: This modifier is not used to report the elective
				  cancellation of a procedure prior to the patient's anesthesia induction and/or
				  surgical preparation in the operating suite. For outpatient hospital/ambulatory
				  surgery center (ASC) reporting of a previously scheduled procedure/service that
				  is partially reduced or cancelled as a result of extenuating circumstances or
				  those that threaten the well being of the patient prior to or after
				  administration of anesthesia, see modifiers 73 and 74 (see modifiers approved
				  for ASC hospital outpatient use).
54 Surgical Care Only
When 1 physician or other qualified health care professional
				  performs a surgical procedure and another provides preoperative and/or
				  postoperative management, surgical services may be identified by adding
				  modifier 54 to the usual procedure number.
Mississippi guideline: The maximum allowable
				  reimbursement for this modifier is 80 percent of the total value of the
				  surgery.
55 Postoperative Management
Only When 1 physician or other qualified health care
				  professional performed the postoperative management and another performed the
				  surgical procedure, the postoperative component may be identified by adding
				  modifier 55 to the usual procedure number.
Mississippi guideline: The maximum allowable
				  reimbursement for this modifier is 20 percent of the total value of the
				  surgery.
56 Preoperative Management Only
When 1 physician or other qualified health care professional
				  performed the preoperative care and evaluation and another performed the
				  surgical procedure, the preoperative component may be identified by adding
				  modifier 56 to the usual procedure number.
57 Decision for Surgery
An evaluation and management service that resulted in the
				  initial decision to perform the surgery may be identified by adding modifier 57
				  to the appropriate level of E/M service.
58 Staged or Related Procedure or Service by
				  the Same Physician or Other Qualified Health Care Professional During the
				  Postoperative Period
It may be necessary to indicate that the performance of a
				  procedure or service during the postoperative period was:
(a) planned or anticipated
				(staged);
(b) more extensive than
				the original procedure; or
(c) for
				therapy following a surgical procedure. This circumstance may be reported by
				adding modifier 58 to the staged or related procedure. Note: For treatment of a
				problem that requires a return to the operating/procedure room, (eg,
				unanticipated clinical condition), see modifier 78.
59 Distinct Procedural Service
Under certain circumstances, it may be necessary to indicate
				  that a procedure or service was distinct or independent from other non-E/M
				  services performed on the same day. Modifier 59 is used to identify
				  procedures/services other than E/M services that are not normally reported
				  together, but are appropriate under the circumstances. Documentation must
				  support a different session, different procedure or surgery, different site or
				  organ system, separate incision/excision, separate lesion, or separate injury
				  (or area of injury in extensive injuries) not ordinarily encountered or
				  performed on the same day by the same individual. However, when another already
				  established modifier is appropriate, it should be used rather than modifier 59.
				  Only if no more descriptive modifier is available, and the use of modifier 59
				  best explains the circumstances, should modifier 59 be used. Note: Modifier 59
				  should not be appended to an E/M service. To report a separate and distinct E/M
				  service with a non-E/M service performed on the same date, see modifier
				  25.
See also Level II (HCPCS/National) Modifiers listing.
62 Two Surgeons
When two surgeons work together as primary surgeons
				  performing distinct part(s) of a procedure, each surgeon should report his/her
				  distinct operative work by adding modifier 62 to the procedure code and any
				  associated add-on code(s) for that procedure as long as both surgeons continue
				  to work together as primary surgeons. Each surgeon should report the co-surgery
				  once using the same procedure code. If additional procedure(s) (including
				  add-on procedure(s)) are performed during the same surgical session, separate
				  code(s) may also be reported with modifier 62 added. Note: If a co-surgeon acts
				  as an assistant in the performance of additional procedure(s), other than those
				  reported with the modifier 62, during the same surgical session, those services
				  may be reported using separate procedure code(s) with modifier 80 or modifier
				  82 added, as appropriate.
Mississippi guideline: This modifier is reimbursed
				  at one hundred fifty percent (150%) of the maximum allowable reimbursement
				  divided equally between the two co-surgeons.
66 Surgical Team
Under some circumstances, highly complex procedures
				  (requiring the concomitant services of several physicians or other qualified
				  health care professionals, often of different specialties, plus other highly
				  skilled, specially trained personnel, various types of complex equipment) are
				  carried out under the "surgical team" concept. Such circumstances may be
				  identified by each participating individual with the addition of modifier 66 to
				  the basic procedure number used for reporting services.
77 Repeat Procedure by Another Physician or
				  Other Qualified Health Care Professional
It may be necessary to indicate that a basic procedure or
				  service was repeated by another physician or other qualified health care
				  professional subsequent to the original procedure or service. This circumstance
				  may be reported by adding modifier 77 to the repeated procedure or service.
				  Note: This modifier should not be appended to an E/M service.
78 Unplanned Return to the Operating/Procedure
				  Room by the Same Physician or Other Qualified Health Care Professional
				  Following Initial Procedure for a Related Procedure During the Postoperative
				  Period
It may be necessary to indicate that another procedure was
				  performed during the postoperative period of the initial procedure (unplanned
				  procedure following initial procedure). When this procedure is related to the
				  first, and requires the use of an operating/procedure room, it may be reported
				  by adding modifier 78 to the related procedure. (For repeat procedures, see
				  modifier 76.)
79 Unrelated Procedure or Service by the Same
				  Physician or Other Qualified Health Care Professional During the Postoperative
				  Period
The individual may need to indicate that the performance of a
				  procedure or service during the postoperative period was unrelated to the
				  original procedure. This circumstance may be reported by using modifier 79.
				  (For repeat procedures on the same day, see modifier 76.)
76 Repeat Procedure or Service by Same
				  Physician or Other Qualified Health Care Professional
It may be necessary to indicate that a procedure or service
				  was repeated by the same physician or other qualified health care professional
				  subsequent to the original procedure or service. This circumstance may be
				  reported by adding modifier 76 to the repeated procedure or service. Note: This
				  modifier should not be appended to an E/M service.
79 Unrelated Procedure or Service by the Same
				  Physician or Other Qualified Health Care Professional During the Postoperative
				  Period
The individual may need to indicate that the performance of a
				  procedure or service during the postoperative period was unrelated to the
				  original procedure. This circumstance may be reported by using modifier 79.
				  (For repeat procedures on the same day, see modifier 76.)
80 Assistant Surgeon
Surgical assistant services may be identified by adding
				  modifier 80 to the usual procedure number(s).
Mississippi guideline: Reimbursement is twenty
				  percent (20%) of the maximum allowable reimbursement.
81 Minimum Assistant Surgeon
Minimum surgical assistant services are identified by adding
				  modifier 81 to the usual procedure number.
Mississippi guideline: Reimbursement is ten percent
				  (10%) of the maximum allowable reimbursement.
82 Assistant Surgeon (when qualified resident
				  surgeon not available)
The unavailability of a qualified resident surgeon is a
				  prerequisite for use of modifier 82 appended to the usual procedure code
				  number(s).
90 Reference (Outside)
				  Laboratory
When laboratory procedures are performed by a party other
				  than the treating or reporting physician or other qualified health care
				  professional, the procedure may be identified by adding modifier 90 to the
				  usual procedure number.
91 Repeat Clinical Diagnostic Laboratory
				  Test
In the course of treatment of the patient, it may be
				  necessary to repeat the same laboratory test on the same day to obtain
				  subsequent (multiple) test results. Under these circumstances, the laboratory
				  test performed can be identified by its usual procedure number and the addition
				  of modifier 91. Note: This modifier may not be used when tests are rerun to
				  confirm initial results; due to testing problems with specimens or equipment;
				  or for any other reason when a normal, one-time, reportable result is all that
				  is required. This modifier may not be used when other code(s) describe a series
				  of test results (eg, glucose tolerance tests, evocative/suppression testing).
				  This modifier may only be used for laboratory test(s) performed more than once
				  on the same day on the same patient.
92 Alternative Laboratory Platform
				  Testing
When laboratory testing is being performed using a kit or
				  transportable instrument that wholly or in part consists of a single use,
				  disposable analytical chamber, the service may be identified by adding modifier
				  92 to the usual laboratory procedure code (HIV testing 86701-86703, and 87389).
				  The test does not require permanent dedicated space; hence by its design may be
				  hand carried or transported to the vicinity of the patient for immediate
				  testing at that site, although location of the testing is not in itself
				  determinative of the use of this modifier.
95 Synchronous Telemedicine Service Rendered
				  Via a Real-Time Interactive Audio and Video Telecommunications
				  System
Synchronous telemedicine service is defined as a real-time
				  interaction between a physician or other qualified health care professional and
				  a patient who is located at a distant site from the physician or other
				  qualified health care professional. The totality of the communication of
				  information exchanged between the physician or other qualified health care
				  professional and the patient during the course of the synchronous telemedicine
				  service must be of an amount and nature that would be sufficient to meet the
				  key components and/or requirements of the same service when rendered via a
				  face-to-face interaction. Modifier 95 may only be appended to the services
				  listed in Appendix P. Appendix P is the list of CPT codes for services that are
				  typically performed face-to-face, but may be rendered via a real-time
				  (synchronous) interactive audio and video telecommunications system.
99 Multiple Modifiers
Under certain circumstances 2 or more modifiers may be
				  necessary to completely delineate a service. In such situations, modifier 99
				  should be added to the basic procedure and other applicable modifiers may be
				  listed as part of the description of the service.
AA Anesthesia Services Performed Personally by
				  Anesthesiologist (HCPCS Modifier)
Report modifier AA when the anesthesia services are
				  personally performed by an anesthesiologist.
AD Medical Supervision by a Physician: More
				  Than Four Concurrent Anesthesia Procedures (HCPCS Modifier)
Report modifier AD when the anesthesiologist supervises more
				  than four concurrent anesthesia procedures.
AS Physician Assistant, Nurse Practitioner, or
				  Clinical Nurse Specialist Services for Assistant at Surgery (HCPCS
				  Modifier)
Assistant at surgery services provided by another
				  qualified individual (e.g., physician assistant, nurse practitioner, clinical
				  nurse specialist, registered nurse first assistant) and not another physician
				  are identified by adding modifier AS to the listed applicable surgical
				  procedures. Modifier AS may be appended to any code identified as appropriate
				  for surgical assistance in this Fee Schedule.
Mississippi guideline: Modifier AS reimbursement is
				  ten percent (10%) of the maximum allowable reimbursement. For assistant at
				  surgery services provided by a physician, see modifiers 80, 81, and
				  82.
M1 Nurse Practitioner (Mississippi
				  Modifier)
This modifier should be added to the appropriate CPT code to
				  indicate that the services were rendered or provided by a nurse practitioner.
M2 Physician Assistant (Mississippi
				  Modifier)
This modifier should be added to the appropriate CPT code to
				  indicate that the services were rendered or provided by a physician assistant.
M3 Physical or Occupational Therapist Assistant
				  (Mississippi Modifier)
This modifier should be added to the appropriate CPT code to
				  indicate that the services were rendered or provided by either a physical
				  therapist assistant or an occupational therapist assistant.
M4 CARF Accredited (Mississippi
				  Modifier)
This modifier should be used in conjunction with CPT code
				  97799 to indicate chronic pain treatment being administered by a CARF
				  accredited provider as part of a pre-approved interdisciplinary pain
				  rehabilitation program.
M5 Chronic Pain Treatment (Mississippi
				  Modifier)
This modifier should be used only in conjunction with CPT
				  code 97799 to indicate chronic pain treatment administered as part of a
				  pre-approved interdisciplinary pain rehabilitation program.
QK Medical Direction of 2, 3, or 4 Concurrent
				  Anesthesia Procedures Involving Qualified Individuals (HCPCS Modifier)
Report modifier QK when the anesthesiologist supervises 2, 3,
				  or 4 concurrent anesthesia procedures involving qualified individuals.
QX CRNA Service with Medical Direction by a
				  Physician
Regional or general anesthesia provided by a CRNA service
				  with medical direction by a physician may be reported by adding modifier
				  QX.
QY Medical Direction of One Certified
				  Registered Nurse Anesthetist by an Anesthesiologist (HCPCS Modifier)
Report modifier QY when the anesthesiologist supervises one
				  qualified certified regi anesthetist.
QZ CRNA Service Without Medical Direction by a
				  Physician
Report modifier QZ with an appropriate CPT code when all
				  anesthesia services are performed by a CRNA.
Mississippi guideline: Modifier QZ reimbursement is
				  eighty percent (80%) of the maximum allowable
				  reimbursement.