Modifiers are two-character descriptors added to a service, or CPT, code, designed to provide additional information about how a service was rendered. Modifiers are generally categorized as one of two types: functional (Level 1) or informational (Level 2). When entering modifiers, it is best to put functional modifiers first, as they often affect the reimbursement rate for services. Claims can include up to four modifiers.
While many modifiers are considered industry standard, not every payer accepts modifiers, and not every modifier is applicable to every service code. Consult your payer contracts or contact Provider Relations for your payers to learn if you should include modifiers with your claims.
In TherapyNotes, modifiers can be manually added per billing line item or automatically added to applicable dates of service through Clinician Billing Setting Overrides, Service Codes settings, or Practice Information and Locations settings.
Automatically Applying Modifiers
Default modifiers can be set for Clinician Billing Setting Overrides, Service Codes, and Practice Locations, and these modifiers are added automatically to any applicable date of service. Modifiers can populate automatically on electronically submitted claims, generated CMS-1500 forms, and superbills.
Set Default Modifiers in a Clinician Billing Setting Override
- Click Staff > Staff Name > Billing tab
- Click anywhere on the Clinician Billing Setting Overrides box to edit.
Click the desired existing override OR + Add Override to create a new override.
- Enter up to four two-character modifier codes in the Default Modifiers fields of the appropriate override.
- Click the Save Changes button.
Set Default Modifiers for Service Codes
- Click Settings > Service Codes
Click the service code you want to add default modifiers to.
- Enter up to four two-character modifier codes in the Default Modifiers fields.
- Click the Save Changes button.
Set Default Modifiers for Practice Locations
- Click Settings > Practice Information and Locations
- Under Practice Locations, click Edit next to the appropriate alternate location.
- Enter up to four two-character modifier codes in the Default Modifiers fields of the appropriate alternate location.
- Click the Save Changes button.
TherapyNotes automatically reorders modifiers on the date of service and corresponding claim according to best practices. If more than four default modifiers apply to a date of service, TherapyNotes will automatically select the most important ones to include on your claim.
Modifiers that are pulled from Clinician Billing Setting Overrides are prioritized, followed by those from Service Codes settings, and finally from Practice Information and Locations settings. Duplicates are removed automatically, and the modifiers are automatically organized to prioritize functional modifiers first and informational modifiers second.
Even if modifiers are applied automatically, they can always be manually changed on a date of service. See the next section for instructions to manually change or apply modifiers.
Manually Applying Modifiers
Even if modifiers are automatically populated for a date of service based on your settings, they can be manually overridden. Manually saving modifiers to a date of service replaces any automatically added modifiers for that date of service only.
Apply a Modifier to a Date of Service
- Click Patients > Patient Name > Patient Billing tab
Click the date of service.
- A dialog with additional details about the date of service appears. The Billing tab is open by default.
- Enter up to four two-character modifier codes in the Modifiers fields.
- Click the Save Changes button