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CPT Modifier 22
Description:
Unusual procedural service (description changed to 'Increased procedural services' for dates of service on or after January 1, 2008)
Guidelines/Instructions:
For dates of service on or after January 1, 2008: the description of this modifier has changed.
- Submit this modifier to indicate that the work required to provide a service is substantially greater than is typically required
- This modifier may only be reported with procedure codes that are specified as having a 0, 10 or 90 day global period
- This modifier may not be submitted with Evaluation and Management (E/M) procedures
- Documentation required with the claim:
- A concise statement that explains the nature of the unusual service or other supporting documentation that the provider deems relevant (such as an operative report), with relevant portions underlined
- The concise statement may be entered in the electronic documentation field or submitted with an electronic claim via the fax attachment process. Services that are submitted with CPT modifier 22 that do not meet these requirements will not be considered for additional reimbursement. (Railroad Medicare does not have a fax attachment process.)
- Palmetto GBA will consider claims submitted with CPT modifier 22 on an individual basis; in other words, there is no set percentage of additional reimbursement. Depending on the documentation, we may or may not allow additional reimbursement.