Modifiers | Physicians Health Plan

Please reference the table below under "How to Use Modifiers Correctly" for direction on using Modifiers. For a complete explanation of Modifier usage, consult the CPT manual.

Modifier – 63

Procedure Performed on Infants less than 4 kg: Procedures performed on neonates and infants up to a present body weight of 4 kg may involve significantly increased complexity and physician or other qualified health care professional work commonly associated with these patients. This circumstance may be reported by adding modifier 63 to the procedure number. Note: Unless otherwise designated, this modifier may only be appended to procedures/services listed in the 20005-69990 code series. Modifier 63 should not be appended to any CPT codes listed in the Evaluation and Management Services, Anesthesia, Radiology, Pathology/Laboratory, or Medicine sections.

Modifier - 76

Modifier 76 Repeat Procedure or Service by Same Physician or Other Qualified Health Care Professional: It may be necessary to indicate that a procedure or service was repeated by the same physician or other qualified health care professional subsequent to the original procedure or service. This circumstance may be reported by adding modifier 76 to the repeated procedure or service. Note: This modifier should not be appended to an E/M service.

How to Use Modifiers Correctly

Modifier	Description	Documentation Required	Applicable Procedure Codes	Applicable to E&M Codes
-22	Unusual services	X	X
-24	Unrelated E&M service by the same physician during a post-op period	X		X
-25	Significant, separately identifiable E&M service by the same physician on same day of a procedure or other service (E/M codes only)	X		X
-50	Bilateral procedure		X
-51	Multiple procedure		X
-52	Reduced services		X
-57	Decision for surgery			X
-59	Distinct procedural service	X	X
-77	Repeat procedure/another physician		X
-78	Return to OR/related procedure		X
-79	Unrelated procedure post-op		X
-80	Assistant surgeon		X
-91	Repeat clinical diagnostic laboratory test		X
JW	Discarded drug not administered	X	X

HCPCS -LT and -RT Modifiers

PHP accepts and encourages the use of the modifiers -LT and -RT when performing the same x-ray bilaterally. Appropriate use of these modifiers can expedite claim processing and eliminate duplicate service denials.

LT - Left side (used to identify procedures performed on the left side of the body)

RT - Right side (used to identify procedures performed on the right side of the body)

Switching Plans is Easy!

Work With Us!