Adding a modifier to a CPT code
Some CPT codes will need a modifier for billing purposes with the insurance company. The instructions below will help you in setting that up. (note: these instructions are using the classic interface)
First, navigate to the payment source that needs the modifier on the CPT code.
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Tools > List Maintenance > Payment Sources
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If the insurance company is waterfalling CPT codes from a different payer, you will need to load up that Insurance Company.
Under the insurance company, load the rates
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You should now see the CPT Code under the Insurance Rate grid
Click on the Edit in the row of the CPT Code that you want to add a modifier to
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Change the CPT Code value to include the modifier.
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The first 2 characters after the CPT Code will be seen as Modifier1 in the EDI file generation.
Save the CPT Code by clicking Update
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The Bill Setup for the Insurance Company will need to have the modifier defined. If it does, generating a new EDI file will contain the modifier that was entered above.
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