How to Use Modifiers for Commercial Payers in Medical Billing - dummies

How to Use Modifiers for Commercial Payers in Medical Billing

To apply more specific payments to procedures in medical billing, many commercial payers require modifiers. Keep in mind, though, that how the modifiers are used differs from payer to payer.

Modifiers 50, 52, RT, and LT

Certain procedural codes are bilateral in their description (that is, the procedure is performed on both sides of the body), while others require the use of a modifier to indicate laterality. Modifier 50 indicates that a procedure was performed bilaterally. If a provider performs a bilateral procedure on one side only, the coder must apply modifier 52 to indicate that the services were reduced.

Some commercial payers recognize the 50 modifiers, essentially agreeing that the procedure was performed twice, once on each side — and process accordingly. Other providers require that the procedure be listed twice on the claim, first with the modifier LT (meaning “left”) and then again with the modifier RT (right).

TC modifier and modifiers 22 and 26

Commercial payers commonly use the TC modifier and Modifier 22:

  • TC modifier and modifier 26: TC means “technical component.” When a radiology service is being billed, the owner of the equipment can bill for its use by applying the TC modifier to the procedural code. The physician who interprets the X-ray can report his services by billing the same procedural code with a 26 modifier, indicating that the physician who didn’t own the equipment did this work.

  • Modifier 22: This modifier is used when a procedure is more extensive or required more time and skill than normal.