Understanding HCFA Claim Modifiers: A Guide for Medical Billing

The American Medical Association developed modifiers used in medical billing that provide additional information for the insurance company when placed on the HCFA 1500 form. These modifiers are two-digit numbers and letters that are used in conjunction with procedure codes and give specific details regarding the services performed. For instance, the modifier RT indicates a procedure was performed only on the right side of the body. Modifiers are an extremely important part of medical billing. Using the correct modifier helps ensure the provider is properly paid for the services performed.

Instructions

• 1

  Enter the Current Procedural Terminology, or CPT, code on line 24D of the HCFA 1500 form. Also, supply procedures for Medicare that fall under the Healthcare Common Procedure Coding System, or HCPCS, on line 24D.

• 2

  Place the first modifier, or the pricing modifier, in the following box. This is the small box beside the first line after the procedure code.

• 3

  Enter additional modifiers, referred to as informational modifiers, in the larger box beside the small box on line 24D. Separate the additional modifiers with a single space.