Modifier Minute: Modifier 32
Modifier 32 Mandated services applies when a third party, such as an insurer or government agency, specifically requests/requires a service on a patient’s behalf. For instance:
• An insurer requests an independent evaluation of a patient filing a workers’ compensation claim
• A school requires that all students receive a physical exam prior to participating in a sports program
• A child in state custody is sent to your office for an examination after being placed in temporary custody or foster care.
• An insurer seeks a “second opinion” on a patient’s condition, prior to authorizing further testing and/or treatment.
For example, a cardiologist determines that a patient needs a mitral valve replacement for a mitral valve prolapse; however, the patient has had this condition for several years. The insurance company covers mitral valve repair, but requires a second surgical consultation prior to surgery.
The cardiologist providing the second opinion should report his service with a modifier 32 to show that the insurance company mandated the service, and therefore should be covered. Failure to report modifier 32 may result in a denial (for instance, due to “duplication of services” because another physician may have already provided the service).
Second opinions or confirmatory consultations requested by the patient, or the patient’s family, do not qualify for modifier 32. Neither is modifier 32 used for a consultation with another physician, or when another physician evaluates a patient for medical clearance prior to a procedure.
Finally, note that Medicare payers generally do not accept modifier 32 claims, and will not pay for a service requested by another provider.