This modifier is used when the modifier field on the claim form has been exhausted. If you need that much room to add modifiers, add the 99 modifiers to the last accessible area and include a characterization of the other modifiers required on the claim.
In some scenarios, two or more modifiers may be required to define a service entirely. In such case scenarios, CPT modifier 99 must be added to the basic procedure, and any other applicable modifiers should be listed as part of the program description.
Modifier -99 may apply to a specific service. The impact of payment or jurisdiction may be determined by the additional modifier(s).
- All procedure codes must be indicated.
- Modifier 99 must be reported in the first position on the service line, whereas all other modifiers must be noted in item 19 or the equivalent electronic data field.
- If the claim has more than one detail line, enter the number of the detail line in Item 19 or the corresponding electronic data field.
- Three different modifiers are indicated in the first three modifier fields, guided by 99 in the fourth.
- Reporting fewer than five modifiers for a single service line
- Modifier 99 claims are paid when they are correctly reported.
Multiple modifiers don’t get much attention —because they’re rarely used — but recognizing when to use them can mean the difference between getting a claim paid and not.
In some cases, two or more modifiers may be required to define a service entirely. Modifier 99 should be added to the basic process in such cases, and any other relevant modifiers should be mentioned as part of the service description. Only use modifier 99 if a single statement item necessitates five or more modifiers. The reason for this is that field 24D on the standard 1500 Health Insurance Claim Form (or electronic equivalent) allows for the entry of up to four modifiers:
If a single line item necessitates more than four modifiers, enter modifier 99 (and only modifier 99) in the first modifier available space in field 24D. All other relevant modifiers should be decided to join in field 19, “Additional Claim Information,” or an electronic data field equivalent. When appropriate, you may use modifier 99 with any CPT® code.
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