Use modifiers as payers require in order to get paid

Article Overview

This article explains a payer-driven modifier billing issue affecting professional claims, focusing on how insurers may request a modifier on evaluation and management services when they are reported with diagnostic testing. It discusses the broader CPT context, references guidance from CPT Assistant, and describes why practices may feel compelled to follow payer-specific requirements even when they disagree with the interpretation. The article is relevant to coders, billers, and pediatric practices dealing with claim submission, denials, and appeals.