BC Advantage - 2009 Issue 5

Modifier 22

When properly appended to an appropriate CPT code, modifier 22 Unusual procedural service allows the provider (often a surgeon) to recover additional reimbursement, above and beyond the regular payment amount, for an especially difficult or time-consuming procedure. When applied properly, however, modifier 22 is not applied often. First and foremost, modifier 22 is appropriate only to describe a truly "unusual" procedure. One might argue convincingly that every brain surgery is difficult, for instance, but not every brain surgery is unusually difficult. Similarly, any individual procedure as described by a specific CPT code may be more or less difficult, or...

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