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Modifier 80 and 82 and adjusting the price

  1. #1
    Default Modifier 80 and 82 and adjusting the price
    Medical Coding Books
    I have a question that has been running around my office for a while related to the appropriate way to bill for surgeries with Modifier 82, and here it is.
    When we bill for modifier 80 or 82 do we need to adjust the price to the 25% of the full amount or we just bill the procedure with the full amount and let the insurance adjust the price by them self?
    In our practice we have been adjusting g the price manually before we send the claim for every charge billed with modifier 82, 80 or 62 but I don't know if this is just an internal police or this is a regulation for everybody.
    Camilo Herrera CPC

  2. #2
    Charleston, WV
    My opinion is that you should always bill your full fee and let the payers cut them according to their policies. There are several reasons:

    1. If you only bill what the payer allows, you will have no way of knowing when/if a payer's allowance has increased. By the time you find out, you've missed out on some additional revenue.
    2. Not every payer has the same policy. It's much easier to bill everyone the same fee than try to keep track of which payer pays what amount.
    3. If you cut the fees you bill the payer, they have no way of knowing if their reimbursements are in line with the prevailing charge. those that subscribe to UCR tables will be reporting your reduced fees resulting in a lower UCR for your area.
    J G Stanley, MHA, CPC

  3. #3
    St. Louis, Missouri
    We always bill the full fee. The insurance company will reduce the payment as needed.

    Melissa Blow, CPC

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