Modifiers
Mandated Services
What is Modifier 32?
One who has received professional services from the physician or other qualified health care professional or another physician or other qualified health care professional of the exact same specialty and subspecialty who belongs to the same group practice, within the past three years.
What is an established patient?
Office or other outpatient visit for the evaluation and management of a new patient, which requires a medically appropriate history and/or examination and low level of medical decision making. When using time for code selection, 30-44 minutes of total time is spent on the date of the encounter.
What is 99203?
What is POS 3 - School?
A problem that may not require the presence of the physician or other qualified health care professional
What is minimal problem?
Significant, Separately Identifiable Evaluation and Management Service by the Same Physician or Other Qualified Health Care Professional on the Same Day of the Procedure or Other Service
What is Modifer 25?
One who has not received any professional services from the physician or other qualified health care professional or another physician or other qualified health care professional of the exact same specialty and subspecialty who belongs to the same group practice, within the past three years.
What is a new patient?
Office or other outpatient visit for the evaluation and management of a new patient, which requires a medically appropriate history and/or examination and high level of medical decision making. When using time for code selection, 60-74 minutes of total time is spent on the date of the encounter.
What is 99205?
The location where health services and health related services are provided or received, through telecommunication technology. Patient is located in their home (which is a location other than a hospital or other facility where the patient receives care in a private residence) when receiving health services or health related services through telecommunication technology.
What is POS 10 - Telehealth Provided in Patient’s Home?
A recent or new short-term problem with low risk of morbidity for which treatment is considered. There is little to no risk of mortality with treatment, and full recovery without functional impairment is expected. A problem that is normally self-limited or minor but is not resolving consistent with a definite and prescribed course is an acute, uncomplicated illness.
What is Acute, uncomplicated illness or injury?
Unrelated Evaluation and Management Service by the Same Physician or Other Qualified Health Care Professional During a Postoperative Period
What is Modifier 24?
When the patient has received professional service(s) from the physician or other qualified health care professional or another physician or other qualified health care professional of the exact same specialty and subspecialty who belongs to the same group practice, during the admission and stay.
Office or other outpatient visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination and straightforward medical decision making. When using time for code selection, 10-19 minutes of total time is spent on the date of the encounter.
What is 99212?
Location, other than a hospital, skilled nursing facility (SNF), military treatment facility, community health center, State or local public health clinic, or intermediate care facility (ICF), where the health professional routinely provides health examinations, diagnosis, and treatment of illness or injury on an ambulatory basis.
What is POS 11 - Office?
A problem that is new or recent for which treatment has been initiated. The patient is improved and, while resolution may not be complete, is stable with respect to this condition.
What is Stable, acute illness?
Multiple Outpatient Hospital E/M Encounters on the Same Date
What is Modifier 27?
What is selecting the E/M Level?
Office or other outpatient visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination and moderate level of medical decision making. When using time for code selection, 30-39 minutes of total time is spent on the date of the encounter.
What is 99214?
A certified facility which is located in a rural medically underserved area that provides ambulatory primary medical care under the general direction of a physician.
What is POS 72 - Rural Health Clinic?
An injury which requires treatment that includes evaluation of body systems that are not directly part of the injured organ, the injury is extensive, or the treatment options are multiple and/or associated with risk of morbidity.
What is Acute, complicated injury?
Preventive Services
What is Modifier 33?
Four types of MDM are recognized: straightforward, low, moderate, and high
What is the Guidelines for Selecting Level of Service Based on Medical Decision Making?
Office or other outpatient visit for the evaluation and management of an established patient that may not require the presence of a physician or other qualified health care professional
What is 99211?
A facility located in a medically underserved area that provides Medicare beneficiaries preventive primary medical care under the general direction of a physician.
What is POS 50 - Federally Qualified Health Center?
An acute illness with systemic symptoms, an acute complicated injury, or a chronic illness or injury with exacerbation and/or progression or side effects of treatment, that poses a threat to life or bodily function in the near term without treatment. Some symptoms may represent a condition that is significantly probable and poses a potential threat to life or bodily function. These may be included in this category when the evaluation and treatment are consistent with this degree of potential severity.◂
What is Acute or chronic illness or injury that poses a threat to life or bodily function?