Wiki Increased Charge for 22 modifier

[kstine713]

Hello!

I just wanted to see what everyone's typical price increase is for a 22 modifier. I am curious for both surgeries and global deliveries. I have seen some suggestions on forums of 20% or 25%, but I was thinking you could potentially lose out on reimbursement with those increases. I have heard of other offices doubling their charge. Any feedback and/or sources to reference would be very much appreciated!

Thank you!
Kaytie

 

[thomas7331]

There isn't a standard value attached to this modifier - the modifier only indicates that the "work required to provide a service is substantially greater than typically required". Some payers, for simplicity sake, will simply allow a 20% or 25% increase in the normal fee schedule if the documentation supports a more difficult than normal procedure, but really the best practice would be to base the amount of extra work on what the documentation reflects and base your increased charges and request for increased reimbursement on what the documentation realistic reflects. So, for example if the documentation supports that the time spent by the provider on a particular case was 50% more than the typical time, you would probably want to increase the charge by 50% and request 50% more reimbursement from you payers. I wouldn't advocate making it an across-the-board amount since this modifier is meant to show a unique case and an exception from the norm.

 

[csperoni]

I agree. Unless your insurance contract with a specific payer addresses reimbursement for -22 modifier, it is reviewed by the insurance on a case by case basis. I am typically using -22 if there was extensive lysis of adhesions requiring additional time. We request additional 20% payment for 30 minutes; additional 30% for 45 minutes; additional 40% for 60 minutes. We do not increase our charge, since the bill goes out with a fee much higher than any insurance contract anyway. We only request an increase on the payment. If I was using -22 for a reason other than extensive lysis of adhesions, I would still base my appeal on the additional time spent.