What is modifier in medical billing?

In medical billing, a modifier is a numeric or alphanumeric code that is appended to a procedure or service code to provide additional information about the circumstances or nature of the procedure or service. Modifiers are used to clarify or provide more detail regarding a procedure or service, and they may affect the amount of reimbursement paid by the insurance company.

Here are some common types of modifiers used in medical billing:

- Date of Service Modifier: Indicates the date the service was actually provided.

- Place of Service Modifier: Indicates the location where the service was provided.

- Code 59 Modifier: Indicates a distinct procedural service.

- Time Modifier: Indicates the time the service was provided.

- Unusual Procedures Modifier: Indicates a procedure or service that is not typically performed or is considered unusual.

- Experimental/Investigational Modifier: Indicates a procedure or service that is still in the experimental or investigational stage and is not yet FDA approved.

- Unlisted Procedure/Service Modifier: Indicates a procedure or service that is not specifically listed in the CPT code book.

Medical billers must use modifiers accurately and appropriately to ensure accurate reimbursement and compliance with insurance company rules and regulations.