Add modifiers and units when they're needed
Claims can be rejected when a required modifier is missing or the number of units is wrong. Most practices only need to remember a small set of rules.
- You've booked the appointment with the correct Service (Lesson 6.2)
- You've confirmed your practice's modifier and unit rules against your payer contracts
Understand modifiers and units
A modifier is a two character addition to a CPT code. It gives the payer more information about the session, such as whether it was telehealth or the provider's licence level.
Units show how many of the code you're billing. Most sessions use 1 unit, while codes based on time can use more.
Add them to the appointment
- Open the appointment in the Calendar and go to the Billing tab.
- Next to Services, click Edit services.
- Update the Units, add any Modifiers, then click Save.
You can also use this view to change the service, price, place of service, or diagnosis, or make the visit self-pay. This lets you make any needed corrections in one place after the session.
Save the rules your practice uses
Most practices use the same few rules for many of their claims. Your list might cover:
- The telehealth modifiers your payers require.
- Clinician level modifiers, such as HO for providers with a master's degree, when the payer expects them.
- Which clinicians bill under a supervising provider's NPI.
- When codes based on time need more than one unit.
- Any payer that uses a different rule from your usual one.
Use your payer contracts or ask your biller to confirm the list. Don't guess, because both missing and incorrect modifiers can cause problems. Write the list down and keep it where whoever does your billing can see it, so the same rules are applied to every appointment.
Tick these off in your own workspace before moving on.
Does every claim need a modifier?
No. Many claims don't need one. Add a modifier only when it applies to the session and the payer requires it.
How do I know which modifiers my practice needs?
Check your payer contracts and provider manuals, or ask your biller if you have one. Don't guess, because an incorrect modifier can cause the same problem as a missing one.
What should I do if a claim has a missing or incorrect modifier?
Correct the claim and submit it again. Then add the rule to your written list so the same problem doesn't happen again.
Can payers require different modifiers for the same service?
Yes, this is common. Keep the modifier most payers use as your default, then add an exception for any payer with a different requirement.