Modifier 25
“Yes, we did a procedure today, but we also performed a full office evaluation that shouldn’t be bundled.”
Example: Patient comes in for knee pain → doctor does full exam + diagnosis + decision making, and also gives a knee injection.
Modifier 24
“Yes, the patient is in a postop period, but today’s visit is for something completely different.”
Modifier 57
The E/M visit where the doctor said “We need to do surgery.”
Modifier 26
Professional component only.
“I’m only billing for the professional component of this service. Someone else provided/owns the equipment and did the technical part.”
Example:
A hospital owns the CT scanner (technical).
A radiologist in their office reviews the images and dictates the report (professional).
The radiologist would bill CT code + this modifier for their piece of the work.
Modifier TC
Technical component only.
The opposite of Modifier 26. Instead of billing for the professional component, you’re billing for the technical component.
Modifier 76
Repeat procedure by same physician. “Same doc repeats”
Used when the same provider repeats the exact same procedure on the same patient on the same day.
This modifier tells them “No mistake — this procedure was done again on purpose.”
Example: A cardiologist does EKG (93005), sees something unclear, and repeats the EKG later that day
Modifier 59
“Yes, these happened on the same day, but they are NOT related. They are totally different procedures.”
Global Period
Right before surgery, during surgery, and the recovery period.
Modifier 77
Repeat procedure by different physician. “Different doc repeats”
A different doctor performs the same procedure again on the same day for the same patient.
Why it’s used: Same concept as modifier 76, but this time a different physician repeats the service.
Example: ER doctor performs an EKG but needs a cardiologist to repeat it for interpretation.→ The cardiologist bills the EKG with this modifier.
Modifier 78
Return to OR for related procedure during postop period. “Uh-oh… take them back to the OR.”
If a patient had surgery, and something goes wrong related to that surgery, and the doctor has to take them back to the OR during the global period, you attach this modifier.
Modifier 79
Unrelated procedure during postop period. “A new problem, new procedure — unrelated to the old surgery.”
Unrelated Procedure or Service by the Same Physician During the Post-Op Period
Modifier 58
Staged or related procedure during the postop period. “This next procedure was supposed to happen — it’s part of the treatment plan.”
The doctor intended from the beginning to do this second procedure.
Example: The surgeon plans a two-stage skin graft. Stage 1 today, stage 2 in two weeks.
Modifier 80
Assistant surgeon. Another surgeon assisted the main surgeon for the entire procedure because the surgery required an extra pair of hands or expertise.
Key points:
-The assistant surgeon is a physician.
-They help with real surgical tasks, not just observing.
-Payment to the assistant is usually about 16% of the main surgeon’s fee.
Modifier 81
Minimum assistant surgeon. Use this modifier when help is needed, but not full-time—only a portion of the surgery required a physician assistant.
Key points:
They assist for limited or partial parts of the surgery.
The help is still medically necessary.
Reimbursed less than modifier 80.
Example: A surgeon needs another doctor to come in only for the closure portion of the procedure.
Modifier 82
Assistant surgeon when a qualified resident is not available. “The hospital usually uses residents as assistants, but none were available — so another surgeon had to help.”
Same as modifier 80 BUT the surgeon is acting as an assistant because no qualified resident was available.
Modifier 62
Two surgeons / co-surgeons. “This surgery was too complex for one surgeon. Two surgeons of different specialties each performed meaningful portions of the SAME CPT code.”
This modifier is used when two surgeons (not assistant surgeons) work together as a team on ONE procedure, because the surgery is:
-So complex
-Or involves multiple specialties
-Or requires skills that one surgeon alone cannot provide
Example: A neurosurgeon and an orthopedic surgeon both work on a complex spinal fusion
Modifier 50
Bilateral procedure. Tells the payer that the same procedure was performed on both sides of the body during the same session by the same provider.
Example: Bilateral ear tubes
❌ The CPT code description already says bilateral
❌ The procedure is midline (no left/right distinction)
❌ Two sides were not actually treated
❌ The payer specifically instructs to report RT/LT instead
Modifier 51
Multiple procedures (same session). The doctor performs more than one procedure
-In the same session
-On the same patient
-And the procedures are not bundled
Important:
Put this modifier on the lower-valued procedure(s), NOT the highest-paying one.
Modifier 52
Reduced services. “The doctor did less than the full service, on purpose or because it was medically appropriate.”
Used when a service or procedure was partially completed, reduced, or not fully performed, but not because of the payer.
Example: A colonoscopy is started but only goes partway because the patient couldn’t tolerate it.
Modifier 53
Discontinued procedure. “We tried, but we had to stop for safety.”
When a physician starts a procedure but cannot finish it because continuing would risk the patient’s life or health.
Modifier 54
Surgical care only. When your provider did ONLY the surgery — not the pre-op or the post-op follow-up.
Example: A patient is visiting from out of town. They have surgery at Hospital A, but after returning home, their local doctor handles all the follow-ups.
Modifier 55
Postoperative care only. The provider only did the postoperative follow-up care, not the surgery and not the pre-op work.
Modifier 56
Preoperative care only. When your provider did the pre-operative evaluation but did NOT perform the surgery or the post-op care.
Modifier AA
Anesthesia performed by anesthesiologist. Insurance pays more when the anesthesia is performed directly by a physician anesthesiologist rather than supervised or performed by a CRNA. This modifier tells insurance the highest level of provider involvement occurred.
