Wiki After hours modifier


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What modifier do I use for After Hours Charges and where do I put the Modifier? Do I put is on the E/M charge or on the cpt code for after hours.
We don't bill a modifier with the after hour codes since the description in the code states it is to be billed "in addition to the basic service."
Melanie, per CPT guidelines you bill it "in addition to the basic service" as stated in the After Hours Code listings in the Miscellaneous Services from the Special Services, Procedure and Reports from the Medicine chapter. It would be nice if you had access to the CPT Assistant directives. You should NOT need a modifier, but I did have a customer service agent from a major carrier tell me (when 99058) was denied and listed on their policy as a billable/allowable code, that putting a modifier on the office visit (25) would most likely help pass it thru the editing process! Per CPT instructions a modifier should not be necessary and question whether the payer preferences in this case would trump. Be prepared to have adequate documentation to back up and be prepared to send notes. Ultimately you might find yourself in the position to have to appeal. This has been MY experience!