How Do Modifiers Affect Reimbursement

In some cases, addition of a modifier may directly affect payment. Placement of a modifier after a CPT or HCPCS code does not insure reimbursement. Medical documentation may be requested to support the use of the assigned modifier.

How can the incorrect use of modifiers affect reimbursement of claims?

Incorrect usage of modifiers can result in revenue loss for a medical practice. If not used appropriately, faulty codes can lead to claims denials, reduced income for practices and compliance issues too.

How do CPT modifiers modify the reimbursement requested?

Modifiers may add information or change the description according to the physician documentation to give more specificity for the service or procedure rendered. Appending of an appropriate modifier will effectively respond to reimbursement.