Modifiers | PreAuthorization / Prior Authorization

A modifier indicates that a procedure was altered but its not changed its definition.


Modifiers may be used as follows:

A service or procedure has both a professional and technical component

A service or procedure was performed by more than one physician

A service or procedure has been increased or reduced

Only part of a service was performed

An additional service was performed

A bilateral procedure was performed more than once

              Unusual events occurred 


Modifier 21 - Prolonged Evaluation and Management Services (Deleted, please use CPT 99354- 99357) 

Modifier 22 -  Unusual Procedural Services

Modifier 23 -  Unusual Anesthesia

Modifier 24 -  Unrelated Evaluation and Management Service by the Same Physician during a Postoperative Period

Modifier -25 Significant, Separately Identifiable Evaluation and Management Service by the Same Physician on the Same Day of the Procedure or Other Service

Modifier 26- Professional Component

Modifier 27 - Multiple Outpatient Hospital E/M Encounters on the Same Date

Modifier 32 -  Mandated Services

Modifier 47 -  Anesthesia by Surgeon

Modifier 50 - Bilateral Procedure

Modifier 51 - Multiple Procedures


Modifier 58 - Related service/procedure was performed  by same physician/different physician in same group during post operative period


Modifier 79 - Unrelated service/procedure was performed  by same physician/different physician in same group during post operative period


Modifier 76 - Repeat the service/procedure was performed  by same physician/different physician in same group during post operative period. It is not necessary to use in same day.


Modifier 77 - Repeat the service/procedure was performed  by different physician during post operative period. It is not necessary to use in same day. or service.


Modifier LT -  Used to identify procedures performed on the left side of the body.


Modifier RT - Used to identify procedures performed on the right side of the body.


Modifier 52 - Under certain circumstances a service or procedure is partially reduced or eliminated at the physician's discretion. 


Modifier 53 - Used to identify  a surgical or diagnostic procedure has been discontinued by physician under certain circumstances


Modifier 54 - Use with surgical codes when one physician performs a surgical procedure and another provides preoperative and/or postoperative management.


Modifier 55 -   Use with surgical codes when one physician performed the postoperative management and another physician performed the surgical procedure. 


Modifier 78 - - Use on surgical codes only to indicate that another procedure was performed during the postoperative period of the initial procedure.


Modifier 80 - Surgical assistant services may be identified by adding the modifier -80 to the usual procedure number(s)

PreAuthorization / Prior Authorization

Prior authorization is a requirement that your physician obtain approval from your health plan to prescribe a specific treatment/service for you. Without this prior approval, your health plan may not provide coverage, or pay for you.