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Mod 22 - new CPC-A


Best answers
What is the correct procedure to process modifier 22.
Do you increase price and attach the notes on first submission?
Do you increase price and wait for insurance to request notes?

Do you increase the price?

I'm hearing all sorts of answers......


True Blue
Midvale, UT
Best answers
For me, it depends on how the insurance wants the claim billed, if it is paper I send a letter explaining why we are requesting additional payment. If it is electronic like Medicare I wait to see how they process the claim and if they deny or pay only the allowable then I send a redetermination explaining why we are requesting additional payment. I do not adjust the price that we bill out.