Modifier Check

[MADION]

Hi all. I'm trying to look up a CPT code and see if the modifier is billable with that code. I thought there was a program through Medicare or somewhere that I can type it in and check. Does anyone know of something like that??

Thanks,
Marianne

 

[cpc2007]

Hi - yes you can use the Medicare Physician Fee Schedule Lookup Tool to determine this information: https://www.cms.gov/medicare/physician-fee-schedule/search?. There are modifier indicators for modifier 51, 50, the global modifiers (78, 58, 79), 26/TC.

Here's a link from CMS that explains the different modifier indicators you will find: https://www.cms.gov/Outreach-and-Ed...s/Downloads/How_to_MPFS_Booklet_ICN901344.pdf

I hope that helps

Kim
www.codingmastery.com

 

[MADION]

Hi - yes you can use the Medicare Physician Fee Schedule Lookup Tool to determine this information: https://www.cms.gov/medicare/physician-fee-schedule/search?. There are modifier indicators for modifier 51, 50, the global modifiers (78, 58, 79), 26/TC.

Here's a link from CMS that explains the different modifier indicators you will find: https://www.cms.gov/Outreach-and-Ed...s/Downloads/How_to_MPFS_Booklet_ICN901344.pdf

I hope that helps

Kim
www.codingmastery.com

That did help I think. I went to the site and typed in 15271 and the modifier column was blank. Does that mean modifiers are not used with this code?

 

[trarut]

If I recall, I've only seen an entry in the Modifiers column if it's a 26 or TC modifier. If you move the slider to the right, you'll see columns for bilateral, co-surgeon, etc. The table will not show you every modifier option so whether this will help you depends on the modifier information you're trying to find.

 

[sls314]

That did help I think. I went to the site and typed in 15271 and the modifier column was blank. Does that mean modifiers are not used with this code?

If you have access to an online encoder, it may tell you the modifiers most commonly billed with a CPT. I know for sure that Find-A-Code does. I assume Codify might have that information as well.

 

[sls314]

It's not telling you that those are the only ones ever allowed for that CPT, but it will tell you the ones that providers most typically bill to Medicare for that CPT. Perhaps that information would be sufficient for what you need?

 

[trarut]

If you have access to an online encoder, it may tell you the modifiers most commonly billed with a CPT. I know for sure that Find-A-Code does. I assume Codify might have that information as well.

Codify does have modifier crosswalks in the code details.