Wiki Modifier 22 and RVUs

[scoriston]

Hello all, I'm trying to find out if using modifier 22 increases the RVUs for a CPT code. Any help is greatly appreciated!!

 

[amyjph]

It's not the RVUs, it's the reimbursement amount. However, depending on how your revenue cycle is set up and if physicians are paid on RVU there may need to be some adjustment made for calculations in your system.

While you would use the RVU of median work time to calculate a fee to bill for the 22 mod, it isn't going to "change" the RVU of the code.

https://www.aapc.com/blog/33193-maximize-reimbursement-using-modifier-22/

https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/Downloads/clm104c12.pdf

"20.4.6 - Payment Due to Unusual Circumstances (Modifiers “-22” and “-52”) (Rev. 1, 10-01-03) B3-15028 The fees for services represent the average work effort and practice expenses required to provide a service. For any given procedure code, there could typically be a range of work effort or practice expense required to provide the service. Thus, A/B MACs (B) may increase or decrease the payment for a service only under very unusual circumstances based upon review of medical records and other documentation."

https://www.wpsgha.com/wps/portal/mac/site/claims/guides-and-resources/modifier-22/!ut/p/z0/fY2xDoIwFEV_RQfG5hVMCCsaDTEQjYPBLqaWAk-hhbaI_r3o5GAc78k99wKDHJjid6y4Q614M-UTC8_7JAkTP6LpLsgojbPNcbGO0mV08GEL7H9hWsBr37MYmNDKyYeDfOzs7BOUm0lVNWhrjzrdoSBiYtJ4VDQcW-vRasBCWsJVQYy0ejBCTrTVBZYoDQmC90FgslVWAeu4qwmqUkP-y4P82-tu7PIc4_kLA8rO-w!!/#

"We determine the amount of reimbursement based on the information in the documentation."

https://www.aapc.com/blog/24809-modifier-22-is-the-exception-not-the-rule/

https://www.aapc.com/blog/63312-when-to-append-modifier-22/

 

[scoriston]

It's not the RVUs, it's the reimbursement amount. However, depending on how your revenue cycle is set up and if physicians are paid on RVU there may need to be some adjustment made for calculations in your system.

While you would use the RVU of median work time to calculate a fee to bill for the 22 mod, it isn't going to "change" the RVU of the code.

https://www.aapc.com/blog/33193-maximize-reimbursement-using-modifier-22/

https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/Downloads/clm104c12.pdf

"20.4.6 - Payment Due to Unusual Circumstances (Modifiers “-22” and “-52”) (Rev. 1, 10-01-03) B3-15028 The fees for services represent the average work effort and practice expenses required to provide a service. For any given procedure code, there could typically be a range of work effort or practice expense required to provide the service. Thus, A/B MACs (B) may increase or decrease the payment for a service only under very unusual circumstances based upon review of medical records and other documentation."

https://www.wpsgha.com/wps/portal/mac/site/claims/guides-and-resources/modifier-22/!ut/p/z0/fY2xDoIwFEV_RQfG5hVMCCsaDTEQjYPBLqaWAk-hhbaI_r3o5GAc78k99wKDHJjid6y4Q614M-UTC8_7JAkTP6LpLsgojbPNcbGO0mV08GEL7H9hWsBr37MYmNDKyYeDfOzs7BOUm0lVNWhrjzrdoSBiYtJ4VDQcW-vRasBCWsJVQYy0ejBCTrTVBZYoDQmC90FgslVWAeu4qwmqUkP-y4P82-tu7PIc4_kLA8rO-w!!/#

"We determine the amount of reimbursement based on the information in the documentation."

https://www.aapc.com/blog/24809-modifier-22-is-the-exception-not-the-rule/

https://www.aapc.com/blog/63312-when-to-append-modifier-22/

You are a lifesaver, thank you so much!