CPT Modifier 22

Description
Increased procedural service.

Guidelines/Instructions

  • 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 and operative report
      • 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.
      • The concise statement may appear on the operative report, but it must be clearly identified. You may circle, underline, highlight or write the concise statement on the operative report.
    • Failure to submit the appropriate information will result in a denial of the claim
  • 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.

Reference: CMS Pub. 100-04, Chapter 12 (PDF, 1.12 MB)

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