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Modifiers Pertaining to Surgery or Services within the Global Period
Modifiers assure that the carrier will give consideration to the special
circumstances that may affect payment. Omitting modifiers may result in
payment denials. If a review is requested on a denied service, the appropriate
modifier must be included with the review. A description of the service will not be
sufficient to change the original claim decision. Use of the modifiers in this
section applies to both major procedures with a 90-day postoperative period and
minor procedures with a 10-day postoperative period (and/or a zero day
postoperative period in the case of CPT modifiers 22 and 25.
CPT Modifier 22 – Unusual Procedural Services
When the service(s) provided is greater than that usually required for the listed
procedure, it may be identified by adding CPT modifier 22 to the usual procedure
number.
 Use of this modifier requires additional documentation. Examples include
an operative report and a concise statement specifying how the service
differs from the usual.
 This information must be in the appropriate documentation record or sent
via FAX for electronic claims.
 If paper claims are submitted, the information must be on an attachment to
the CMS-1500 claim form.
 Failure to submit the documentation appropriately may result in payment
for the surgical code only, based on the Medicare Physician Fee Schedule
Database.
CPT Modifier 24 – Unrelated Evaluation and Management Service by the
Same Physician During a Postoperative Period
The physician 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 the CPT
modifier 24 to the appropriate level of E/M service.
 Additional documentation required with this modifier is: sufficient
documentation to establish that the visit was unrelated to the surgery; an
ICD-9 diagnosis code that clearly indicates that the reason for the
encounter was unrelated to the surgery.
 The documentation to establish the visit was unrelated to the surgery must
appear in the appropriate documentation record for electronic claims or on
an attachment to the CMS-1500 claim form for paper claims.
 Failure to submit this documentation appropriately may result in services
denied as part of the cost of the surgical procedure.
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CPT Modifier 25 – Significant, Separately Identifiable Evaluation and
Management Service by the Same Physician on the Same Day of the
Procedure or Other Service
The physician may need 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.
 The E/M service may be prompted by the symptom or condition for which
the procedure and/or service was provided.
 Different diagnoses are not required for reporting the E/M services on the
same date. This circumstance may be reported by adding the CPT
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 CPT modifier 57.
CPT Modifier 50 – Bilateral Procedure
Unless otherwise identified in the listings, bilateral procedures that are performed
at the same operative session must be identified by adding the CPT modifier 50
to the appropriate five-digit code.
Note: To prevent duplicate denials, surgical procedures billed bilaterally must be
reported using the surgical code and the 50 CPT modifier billed on one detail.
CPT Modifier 51 – Multiple Procedures
When multiple procedures, other than Evaluation and Management Services, are
performed at the same session by the same provider, the primary procedure or
service may be reported as listed. The additional procedure(s) or service(s) may
be identified by appending the CPT modifier 51 to the additional procedure or
service code(s).
Note: This modifier must not be appended to designated "add-on" codes.
CPT Modifier 52 – Reduced Services
Under certain circumstances a service or procedure is partially reduced or
eliminated at the physician's discretion. Under these circumstances, the service
provided can be identified by its usual procedure number and the addition of the
CPT 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
and/or 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 CPT modifiers 73 and 74 (see modifiers
approved for ASC hospital outpatient use).
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Use of this modifier requires additional documentation such as an
operative report and a concise statement specifying how the service
differs from the usual.
This information must be indicated in the appropriate documentation
record for electronic claims or sent via FAX. It may also be attached to the
CMS-1500 claim form for paper claims.
Failure to submit this documentation appropriately may result in services
rejected as unprocessable.
CPT Modifier 53 – Discontinued Procedure
Under certain circumstances, the physician 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 must be
reported by adding the CPT modifier 53 to the code reported by the physician 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 CPT modifiers 73 and 74 (see modifiers approved for ASC hospital
outpatient use).
 Use of this modifier requires additional documentation such as a
statement indicating why it was medically necessary to discontinue the
procedure.
 The statement must be indicated in the appropriate documentation record
for electronic claims. If paper claims are submitted, the statement must
appear on an attachment to the CMS-1500 claim form.
 Failure to submit this documentation appropriately may result in services
rejected as unprocessable.
CPT Modifier 54 – Surgical Care Only
When one physician performs a surgical procedure and another provides
preoperative and/or postoperative management, surgical services must be
identified by adding the CPT modifier 54 to the usual procedure number.
CPT Modifier 55 – Postoperative Management Only
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When one physician performs the postoperative management and another
physician performs the surgical procedure, the postoperative component must be
identified by adding the CPT modifier 55 to the usual procedure number.
Use of this modifier requires additional documentation and includes both the
number of days postoperative care is provided, and the assumed or relinquished
dates of the postoperative care.
 The number of postoperative days and the assumed or relinquished dates
must be indicated in the appropriate documentation record for electronic
claims.
1. For paper claims, the number of postoperative days must be
indicated in Item 24g and the assumed or relinquished dates must
be indicated in Item 19 of the CMS-1500 claim form.
2. Failure to submit this documentation appropriately may result in the
services rejected as unprocessable.
 Claims for postoperative management only should also show the surgery
as the procedure code and the date of the surgery as the date of service
and the number of postoperative days the patient was seen.
CPT Modifier 56 – Preoperative Management Only
When one physician performs the preoperative care and evaluation and other
physician performs the surgical procedure, the preoperative component must be
identified by adding the CPT modifier 56 to the usual procedure number.
CPT Modifier 57 – Decision for Surgery
An evaluation and management service that resulted in the initial decision to
perform the surgery must be identified by adding the CPT modifier 57 to the
appropriate level of E/M service.
CPT Modifier 58 – Staged or Related Procedure or Service by the Same
Physician during the Postoperative Period
The physician may need to indicate that the performance of a procedure or
service during the postoperative period was: a) planned prospectively at the time
of the original procedure (staged); b) more extensive than the original procedure;
or c) for the therapy following a diagnostic surgical procedure. This circumstance
must be reported by adding the CPT modifier 58 to the staged or related
procedure.
Note: This modifier is not used to report the treatment of a problem that requires
a return to the operating room. See CPT modifier 78.
CPT Modifier 59 – Distinct Procedural Service
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Under certain circumstances, the physician may need to indicate that a
procedure or service was distinct or independent from other services performed
on the same day. CPT modifier 59 is used to identify procedures/services that
are not normally reported together, but are appropriate under the circumstances.
 This may represent a different session or patient encounter, 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 physician.
 When another modifier is appropriate it should be used rather than CPT
modifier 59.
CPT Modifier 62 – Two Surgeons
When two surgeons work together as primary surgeons performing distinct
part(s) of a single reportable procedure, each surgeon must report his/her distinct
operative work by adding the CPT modifier 62 to the single definitive procedure
code.
 Each surgeon must 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 be reported
without the CPT modifier 62 added.
Note: If a co-surgeon acts as an assistant in the performance of additional
procedure(s) during the same surgical session, those services may be reported
using separate procedure code(s) with the CPT modifier 80 or CPT modifier 81
added, as appropriate.
CPT Modifier 66 – Surgical Team
Under some circumstances, highly complex procedures (requiring the
concomitant services of several physicians, often of different specialties, plus
other highly skilled, specially trained personnel, and various types of complex
equipment) are carried out under the "surgical team" concept.
 Such circumstances must be identified by each participating physician
with the addition of the CPT modifier 66 to the basic procedure number
used for reporting services.
CPT Modifier 76 – Repeat Procedure by Same Physician
The physician may need to indicate that a procedure or service was repeated
subsequent to the original procedure or service. This circumstance must be
reported by adding the CPT modifier 76 to the repeated procedure/service.
CPT Modifier 77 - Repeat Procedure by Another Physician
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The physician may need to indicate that a basic procedure or service performed
by another physician had to be repeated. This situation must be reported by
adding CPT modifier 77 to the repeated procedure/service.
78 Return to the Operating Room for a Related Procedure During the
Postoperative Period
The physician may need to indicate that another procedure was performed
during the postoperative period of the initial procedure. When this subsequent
procedure is related to the first, and requires the use of the operating room, it
must be reported by adding the CPT modifier 78 to the related procedure.
 For repeat procedures on the same day, see CPT modifier 76.
CPT Modifier 79 Unrelated Procedure or Service by the Same Physician
During the Postoperative Period
The physician may need to indicate that the performance of a procedure or
service during the postoperative period was unrelated to the original procedure.
This circumstance must be reported by using the CPT modifier 79. For repeat
procedures on the same day, see CPT modifier 76.
CPT Modifier 80 – Assistant Surgeon
Surgical assistant services may be identified by adding the CPT modifier 80 to
the usual procedure number(s).
 Additional documentation required with this modifier includes a statement
that no qualified resident was available to perform the service, or a
statement indicating that no exceptional medical circumstances exist, or a
statement indicating the primary surgeon has an across the board policy
of never involving residents in the preoperative, operative or postoperative
care of his/her patients.
1. If one of the above is not provided, the name and address of the
hospital where the services were furnished must be indicated.
 The statement must be submitted in the appropriate documentation record
for electronic claims and on an attachment to the CMS-1500 claim form for
paper claims.
2. The name and address of the hospital where services were
furnished must be indicated in the appropriate documentation
record for electronic claims and in Item 32 of the CMS-1500 claim
form for paper claims.
3. Failure to submit this documentation appropriately may result in
services rejected as unprocessable.
CPT Modifier 81 – Minimum Assistant Surgeon
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Minimum surgical assistant services are identified by adding the CPT modifier 81
to the usual procedure number.
 Additional documentation is required with this modifier and includes a
statement that no qualified resident was available to perform the service,
or a statement indicating that no exceptional medical circumstances exist,
or a statement indicating the primary surgeon has an across the board
policy of never involving residents in the preoperative, operative or
postoperative care of his/her patients.
1. If one of the above is not provided, the name and address of the
hospital where the services were furnished must be indicated.
 The statement must be submitted in the appropriate documentation record
for electronic claims and on an attachment to the CMS-1500 claim form for
paper claims.
2. The name and address of the hospital where services were
furnished must be indicated in the appropriate documentation
record for electronic claims or in Item 32 of the CMS-1500 claim
form for paper claims.
3. Failure to submit this documentation appropriately may result in
services rejected as unprocessable.
CPT Modifier 82 Assistant Surgeon (When Qualified Resident Surgeon is
not Available)
The unavailability of a qualified resident surgeon is a prerequisite for use of CPT
modifier 82 appended to the usual procedure code number(s).
CPT Modifier 99 – Multiple Modifiers
Under certain circumstances, two or more modifiers may be necessary to
completely delineate a service. In such situations, CPT modifier 99 must be
added to the basic procedure, and other applicable modifiers must be listed as
part of the description of the service.
HCPCS Modifier AS – Assistant At Surgery
Physician assistant, nurse practitioner, or clinical nurse specialist services for
assistant at surgery are identified by adding the HCPCS modifier AS to the usual
procedure code number.
 Additional documentation is required with this modifier and includes a
statement that no qualified resident was available to perform the service,
or a statement indicating that no exceptional medical circumstances exist,
or a statement indicating the primary surgeon has an across the board
policy of never involving residents in the preoperative, operative or
postoperative care of his/her patients.
1. If one of the above is not provided, the name and address of the
hospital where the services were furnished must be indicated.
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The statement must be submitted in the appropriate documentation record
for electronic claims or on an attachment to the CMS-1500 claim form for
paper claims.
1. The name and address of the hospital where services were
furnished must be indicated in the appropriate documentation
record for electronic claims or in Item 32 of the CMS-1500 claim
form for paper claims.
2. Failure to submit this documentation appropriately may result in
services rejected as unprocessable.
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