decisionhealth Newsletters, Part B News - 2020 Issue 12 (December)
Use of E/Ms with modifier 24 remains stable, but denial rates fall hard
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Article Overview
This article reviews Medicare claims data on evaluation and management services reported with modifier 24 and compares utilization and denial patterns across years. It is aimed at coding and billing professionals who monitor postoperative-period billing, denial trends, and specialty-specific claim patterns. The discussion focuses on broad trends, code-level usage, and changes in denial rates without providing instructional guidance.
Why This Topic Matters
Modifier 24 use can affect claim processing and denial patterns, so understanding how it appears in Medicare data helps billing and coding teams benchmark performance and monitor audit or denial risk trends.
What You Will Learn
- How Medicare claims data reflects evaluation and management services billed with modifier 24
- Which broad service categories and specialties appear most often in the reported data
- How denial patterns changed over time for modifier 24 claims
- How to interpret high-level utilization and denial trend reporting for postoperative-period E/M services
Who Should Read This
- Medical coders
- Billing professionals
- Revenue cycle staff
- Compliance teams
- Practice managers
- Specialty practices using E/M services
Codes Discussed
Code Ranges Discussed
Modifiers Discussed
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