Billing modifier

What does Billing modifier mean on a medical bill?

A modifier is a short add-on attached to a procedure code that says something about the circumstances: that a service was separate from another one that day, that a test was repeated, that only the doctor's half or only the equipment half is being billed, that the procedure was done on both sides. Modifiers change how much a line pays, which is why they matter to a bill review. They are legitimate tools, and they are also where a package quietly becomes several paid lines.

What should I watch out for with Billing modifier?

• Ask which modifier was used on a line and what circumstance it was meant to describe
• A modifier that splits one package into several paid lines — ask what the records show
• The same test billed twice with a repeat modifier — ask to see both results