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.
Tools > List Maintenance > Payment Sources
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
In the procedure grid, edit the procedure that contains the CPT Code
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
Change the CPT Code value to include the modifier.
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
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.
