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Thread: Use of modifier with unlisted CPT code

  1. #1
    Join Date
    Apr 2007
    Long Beach

    Default Use of modifier with unlisted CPT code

    AAPC: Back to School
    For the life of me I cannot find this, but I thought I read somewhere that you cannot use a modifier on an unlisted CPT code. Can somebody validate this for me, or let me know if I am delusional. Thanks

  2. #2

    Default modifiers and unlisted procedure codes

    I read that just recently too. But I cannot find it either. Maybe it was the encoder that gave me the edit note. But I don't use a modifier with the unlisted codes.

  3. #3
    Join Date
    Apr 2007
    San Diego


    I've read the same thing & also covered it in my prep course before taking my test. I also did find it in "writing" on an old Medicare Webinar Q&A page, here's the link:

    Sylvia Thompson, CPC
    Billing Supervisor
    San Diego, CA

  4. #4
    Join Date
    Apr 2007
    Louisville, KY


    CPT Assistant made note a couple years ago that modifiers applied to unlisted CPT is inappropriate.
    Kevin B. Shields, RHIT, CPCO, CCS, CPC, COC, CCS-P, CPC-P, CPC-I

  5. #5
    Join Date
    Apr 2007

    Red face

    A global period indicator of "YYY" describes carrier priced codes (often unlisted codes) and the allowance determination will take into account all aspects of the procedure performed. A 22 modifier would be inappropriate on an unlisted code, that I know for sure. Hope it helps.
    E. Frohna
    Evangelina Frohna, CPC, CEMC

  6. #6


    Hi, Please note that Bilateral modifier indicator provided by CMS shows that "150% bilateral payment adjustment applies", which means you can use modifers 50, LT, RT with unlisted CPT against which it is mentioned as "150% bilateral payment adjustment applies" Ex-54699. I confirmed this from Supercoder site. THANKS.
    Last edited by karansinghchauhan; 05-13-2013 at 07:29 AM.

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