Medical billing modifiers are essential for accurate reimbursement and claim approval. Incorrect modifier usage is one of the leading causes of claim denials.
Top Medical Billing Modifiers
| Modifier | Description |
|---|---|
| 25 | Significant Separately Identifiable E/M Service |
| 59 | Distinct Procedural Service |
| 95 | Telehealth Service |
| GA | Waiver of Liability Statement |
ICD-10 Examples
- E11.9 – Type 2 diabetes mellitus
- I10 – Essential hypertension
- M54.5 – Low back pain
Common Modifier Denials
- Modifier missing
- Invalid modifier combination
- Incorrect telehealth modifier
- Modifier not supported by payer
Payer-Specific Modifier Tips
- Medicare frequently audits modifier 25 usage.
- BCBS may reject unsupported modifier 59 claims.
- Commercial payers vary on telehealth modifier requirements.
Internal Resources
FAQ
What is modifier 25 used for?
Modifier 25 indicates a separately identifiable E/M service performed on the same day.