Question:

Do modifiers ever replace a CPT® or HCPCS code?

Answer:

It is important to always remember that modifiers do not replace a CPT or HCPCS code, but are used to add clarity to the actual studies performed. Ask yourself the following questions regarding modifier usage. If you answer “yes” to the question, then it is appropriate to use the applicable modifier.

  • Will the modifier add more information regarding the anatomic site of the procedure?
  • Will the modifier help to eliminate the appearance of duplicate billing?
  • Would a modifier help to eliminate the appearance of unbundling?
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Fee schedules, relative value units, conversion factors and/or related components are not assigned by the AMA, are not part of CPT, and the AMA is not recommending their use. The AMA does not directly or indirectly practice medicine or dispense medical services. The AMA assumes no liability for data contained or not contained herein.

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