Quick Tips to Apply CPT Add-on Codes
by John Verhovshek, MA, CPC
Here are a few quick tips to help you make the most of CPT “add-on” codes:
- Add-on codes describe procedures or services that are always provided “in addition to” other, related services or procedures. Add-on codes cannot stand alone as separately reportable services.
- Add-on codes are identified throughout the CPT® manual by a “+,” and their descriptor will contain some variation of the phrase “report in addition to code for primary procedure.” You can find a complete list of add-on codes in Appendix D of the CPT® manual.
- Add-on codes have no global period assigned. They are instead “included” in the global surgical fee for the primary procedure.
- Add-on codes are “modifier 51 exempt,” and therefore are to be paid at full fee schedule value. Their assigned value accounts for the “additional” nature of the procedure.
- It’s best practice to periodically check your explanation of benefits carefully for claims with add-on codes to be sure the payer is reimbursing you the entire fee schedule rate for the billed procedures or services. If you find a payer reducing the fees for your add-on codes, be sure to appeal the claims.
John Verhovshek, MA, CPC, is Managing Editor at AAPC. He has covered medical coding and billing, healthcare policy, and the business of medicine since 1999. He is an alumnus of York College of Pennsylvania and Clemson University, and a member of the Asheville-Hendersonville AAPC Local Chapter.