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Procedure Code Modifiers

As defined by the Physicians’ Current Procedural Terminology/Healthcare Common Procedure Coding System (CPT/HCPCS), a modifier is a two-character (alpha and/or numeric) code that is appended to the CPT/HCPCS procedure code to clarify the services being billed.

The modifier indicates that the service or procedure performed has been altered by some specific circumstance but not changed in its definition or code.

Modifiers are grouped into two levels described below:
Level I:  Modifiers and descriptors that are copyrighted by the American Medical Association
Level II: Modifiers and descriptors approved and maintained by CMS’ Alpha-Numeric Editorial Panel

Understanding how and when to use a CPT/HCPCS modifier is vital for proper reporting of medical services and procedures.

Blue Cross and Blue Shield of Alabama will accept modifiers that comply with the Health Insurance Portability and Accountability Act (HIPAA) legislation. Many modifiers are considered “informational only” and do not affect the processing of the claim or reimbursement. The lack of modifiers or the improper use of modifiers can result in claims delays or claims denials. Following are some of the modifiers that Blue Cross recognizes or requires:

Last Updated March 2010