A modifier is a two-character addition to a procedure code that tells the payer something changed about the service without changing its definition. Here are the ones practices use most. Always confirm payer-specific rules, because policies differ.
Evaluation and management modifiers
- 25 — a significant, separately identifiable visit on the same day as a procedure. Used often, and watched closely by payers.
- 24 — an unrelated visit during a post-operative global period.
- 57 — the visit that resulted in the decision to perform major surgery.
Procedure modifiers
- 59 — a distinct procedural service, used to show that procedures normally bundled were truly separate. Medicare also uses the more specific XE, XS, XP and XU modifiers for the same purpose.
- 50 — a bilateral procedure performed on both sides.
- LT and RT — left side and right side.
- 76 and 77 — a repeat procedure by the same physician (76) or another (77).
Surgery follow-up modifiers
- 58 — a staged or related procedure during the post-operative period.
- 78 — an unplanned return to the operating room for a related procedure during the post-operative period.
- 79 — an unrelated procedure during the post-operative period.
Diagnostic and testing modifiers
- 26 — professional component only, such as the physician's interpretation.
- TC — technical component only, such as the equipment and staff.
- 91 — a repeat clinical diagnostic lab test on the same day.
Telehealth
- 95 — a synchronous telemedicine service delivered by real-time audio and video. Payers differ on which modifiers and place-of-service codes they want, so check each one.
Why modifier mistakes are costly
Missing modifiers can cause denials for bundling or duplicate billing. Overusing modifiers such as 25 and 59 can draw audit attention. Both cost money, which is why modifier accuracy is a core part of our medical coding work. For specialty examples, see orthopedic, radiology and anesthesia billing.
Frequently Asked Questions
Does modifier 25 always get paid?
No. Payers want to see that the visit was significant and separate from the procedure, and that the documentation shows it.
What is the difference between 26 and TC?
26 is the professional component (interpretation), TC is the technical component (equipment and staff). Together they make up the global service.
Want help with your billing?
Get a free review of your collections, denials and A/R.