Does it matter what position pricing modifiers are submitted on a claim?

Answer:
Yes. The Multi-Carrier System (MCS) used for claims processing requires placement of pricing modifiers in the first modifier position to process claims correctly.

Processing delays or rejections can occur for claims submitted without the pricing modifier in the first modifier position.

HCPCS Modifier
Description
AA  Anesthesia service personally performed by anesthesiologist 
AD
Medical supervision by a physician; more than four concurrent anesthesia procedures
AS*
Assistant at surgery services provided by a Physician Assistant (PA) or Nurse Practitioner (NP)
KD
Drug administered through a DME infusion pump
QK
Medical direction of two, three or four concurrent anesthesia procedures involving qualified individuals
QW
CLIA waived tests
QX
Certified Registered Nurse Anesthetist (CRNA) service: with medical direction by a physician
QY
Medical direction of one CRNA by an anesthesiologist
QZ
CRNA service: without medical direction by a physician
TC
Technical component
CPT Modifier
Description
26  Professional component 
50*
Bilateral Procedure performed at the same session on an anatomical site
53
Discontinued procedure (only when appended to procedure codes 45378, G0105, G0121)
54*
The surgeon is billing the surgical care only
55*
Indicate a physician, other than the surgeon, is billing for part of the outpatient postoperative care

Or: Used by the surgeon when providing only a portion of the post-discharge post-operative care
62*
Two surgeons (each in a different specialty) are required to perform a specific procedure
66*
Team surgeons
73*
Discontinued Out-Patient Hospital/Ambulatory Surgery Center (ASC) procedure prior to the administration of anesthesia
78*
Return to an operating room for a related procedure during the postoperative period
80*
Assistant at surgery service is provided by a medical doctor (MD)
81*
To identify minimum surgical assistant services, and is only submitted with surgery codes.
82*
Assistant at surgery service provided by a MD when there is no qualified resident available

* These payment modifiers are not limited to the first position. (If there is another pricing modifier submitted that is required to be in the first modifier field, these modifiers should be in the second, third or fourth modifier position.)

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Provider Contact Center: 888-355-9165

IVR: 877-288-7600

TTY: 877-715-6397

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