Modifier 22 – Procedural Service
- The purpose of this modifier is to report services (surgical or nonsurgical) when the work required to provide a service is substantially greater than typically required.
- This modifier must be used only when additional work factors requiring the physician’s technical skill involve significantly increased physician work, time, and complexity of than when the procedure is normally performed.
o “Substantially Greater” refers to increased intensity, time, technical difficulty of procedure, severity of patient’s condition, and physical and mental effort required, etc.
o Trauma extensive enough to complicate the procedure and cannot be reported with additional procedures.
o Significant scarring requiring extra time and work.
o Extra work resulting from morbid obesity.
o Increased time resulting from extra work by the physician.
- Procedure codes with modifier 22 appended will price at 120% of the allowable charge.
- This modifier may be used with codes in the following sections:
o Anesthesia (00100-01999)
o Surgery (11100-69990)
o Radiology (70010-79999)
o Laboratory and pathology (80047-89356)
o Medicine (90281-99607)
- This modifier is not appended to ELM services (99201-99499).
Clinical Information Requirements:
- Medical records must be available upon request.
- Clinical information documented in the patient’s medical records must support the use of this modifier.