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tci ED Coding & Reimbursement Alert - 2019 Issue 2

Reader Question: Find out Whether Modifiers Have Associated Prices

Question: Using the Resource-Based Relative Value Scale (RBRVS), what are the relative value units (RVUs) for modifiers 25, 26, 51, 52, 57, 59, and 80? Supercoder Subscriber Answer: The official RBRVS as listed in the Medicare Physician Fee Schedule each year assigns no RVUs to any modified code — except for modifier 26 (Professional component) and modifier TC (Technical component). Remember, RVUs simply represent the procedure’s value. Any discounting based on modifiers is subject to individual payer policy. Once you calculate your location’s allowable, you can calculate the Medicare reduction for modifier 80 (Assistant surgeon) or modifier...

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