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Additional fee for Modifier 22?

  1. #1
    Englewood, Colorado
    Default Additional fee for Modifier 22?
    Medical Coding Books
    I need some guidance on what additional fee to charge when appending with -22. Would it be reasonable to charge half of the procedure fee?


    Dea Robinson, MA, CPC

  2. #2
    It depends on the circumstances. Why are you using the modifier -22? Did the surgery take and extra hour? Twice as long as normal? If you and the provider feel the extra work & effort is worth an extra 20%, charge that... if you feel it's worth double your usual reimbursement, then charge that. It just all depends. There is not one answer for this question.


  3. #3
    Englewood, Colorado
    In this instance, a hysterectomy, the uterus was pathologically large and took extra time to remove. Sounds like I could get an idea of how much longer it took and do some kind of percentage off the original procedure code when I append it.


  4. #4
    I've had luck getting about an additional 20 - 25% for each extra hour of work (depending on payor). Your doc should be documenting the nature and time of this extra / unusal work or your appeals will most-likely not be successful.

    Good luck!


  5. #5
    Milwaukee WI
    Default Usually 25%
    When we use the -22 modifier for an exceptionally difficult or long case, we typically increase our fee for that procedure by 25%. (Sometimes a bit more, sometimes a bit less.)

    F Tessa Bartels, CPC, CEMC

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