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This website provides information and news about the Medicare program for health care professionals only. All communication and issues regarding your Medicare benefits are handled directly by Medicare and not through this website. For the most comprehensive experience, we encourage you to visit Medicare.gov or call 1-800-MEDICARE. In the event your provider fails to submit your Medicare claim, please view these resources for claim assistance.

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Medicare Part B drug average sales price external link

Modified: 9/17/2024

Visit the Medicare Part B drug average sales price page on the CMS website

Utilization of Modifier 76: Repeat procedures

Modified: 8/12/2024

Modifier 77

Modified: 7/25/2024

View this article for instructions on how and when to use modifier 77.

Anatomical modifiers

Modified: 7/11/2024

Procedures performed during separate patient encounters, at separate anatomic sites, or on separate specimens, may require a modifier be reported. Avoid claim denials or appeals due to incorrect claim submissions by properly applying anatomical modifiers.

Bilateral indicators

Modified: 7/8/2024

The Medicare physician fee schedule status indicators for bilateral services should be used to determine if the procedure is allowed to be performed bilaterally.

Modifier 50 fact sheet

Modified: 7/8/2024

Modifier 50 applies to bilateral procedures performed on both sides in the same operative session, except as indicated. Avoid claim denials and future appeals due to incorrect claim submissions by properly applying modifier 50 when these instances occur.

Utilizing modifier 91: Repeat clinical laboratory tests

Modified: 7/7/2024

View this article for instructions on how and when to use modifier 91.

Durable medical equipment fee schedule (download files) external link

Modified: 7/5/2024

The DMEPOS fee schedule files are located in the download section of this page.

Modifier 53 fact sheet

Modified: 6/12/2024

To avoid claim denials and future appeals due to these incorrect claim submissions, we’re providing guidance on how to properly submit a claim when applying this modifier.

Modifier AI fact sheet

Modified: 5/28/2024

The principal physician of record appends modifier “-AI” to their initial hospital care or nursing facility visit code. All other physicians who perform an initial evaluation on this patient bill without modifier "-AI" to indicate specialty care.

Modifier 22 fact sheet

Modified: 5/24/2024

Effective August 31, documentation is required for claims submitted with modifier 22. To avoid claim denials and future appeals due to incorrect claim submissions, we’re providing guidance on how to properly submit a claim when applying this modifier.

Modifier 52 fact sheet

Modified: 5/24/2024

Effective August 31, documentation is required for claims submitted with modifier 52. To avoid claim denials and future appeals due to incorrect claim submissions, we’re providing guidance on how to properly submit a claim when applying this modifier.

Postoperative co-management -- modifiers 54 and 55

Modified: 5/23/2024

When physicians transfer the care of the patient during the global care period, the use of a modifier will be necessary to distinguish who is providing care for the patient. This article explains how to properly apply modifiers when these instances may occur.

Modifier 73 fact sheet

Modified: 5/17/2024

Use modifier 73 to report discontinued outpatient or hospital ambulatory surgical center (ASC) procedure prior to the administration of anesthesia.

Modifier 57 fact sheet

Modified: 5/16/2024

View this information about how to use modifier 57.
To avoid claim denials and future appeals due to incorrect claim submissions, we’re providing guidance on how to properly submit a claim when applying modifier 57.

Modifier 24 fact sheet

Modified: 5/8/2024

To avoid claim denials and future appeals due to incorrect claim submissions, we’re providing guidance on how to properly submit a claim when applying modifier 24.

Appropriate use of assistant at surgery modifiers and payment indicators

Modified: 5/8/2024

Here is clarification on the appropriate use of modifiers to report assistant at surgery services and how payment is determined under the Medicare physician fee schedule (MPFS).

Modifier 25 tips

Modified: 5/8/2024

These tips are based on questions posed regarding whether to bill an evaluation and management visit on the same day as a procedure or other services with modifier 25.

Alpha-numeric HCPCS code information external link

Modified: 4/17/2024

This page includes links to files that contain the Level II alphanumeric Healthcare Procedural Coding System (HCPCS) procedure and modifier codes; their long and short descriptions; and applicable Medicare administrative, coverage, and pricing data.

Modifier 25 fact sheet

Modified: 4/8/2024

Specific guidelines apply to the proper application and billing of modifier 25.

Modifier 62 fact sheet

Modified: 3/28/2024

Surgeons append modifier 62 to claims indicating they were co-surgeons on the same patient during the same operative session. When billing a procedure with modifier 62, documentation of the medical necessity for two surgeons may be required.

Modifier 27 fact sheet

Modified: 3/12/2024

Hospitals may append modifier 27 to the second and subsequent outpatient hospital E/M code to indicate the E/M service is a “separate and distinct E/M encounter” from the service previously provided the same day in the same or different hospital setting.

ZIP codes requiring a nine-digit ZIP code (ZIP+4)

Modified: 2/16/2024

To access a file containing the quarterly additions and deletions to the list of ZIP codes requiring a plus four extension refer to this link to the CMS website. [CR 5970]

Clinical laboratory fee schedule (download files) external link

Modified: 1/13/2023

The clinical laboratory fee schedule files are located in the download section of this page.

How to use the MPFS look-up tool (CMS) external pdf file

Modified: 12/6/2021

This booklet shows you how to use the MPFS look-up tool available at cms.gov.

Fee Schedule Lookup Tutorial - Bundled Services

Modified: 8/3/2021

This tutorial will assist you in determining if a procedure is part of a bundled service.

Medicare physician fee schedule payment policy indicators

Modified: 2/5/2021

This provides definitions of the national policy indicators for each procedure code (and modifier, where applicable) on the Medicare physician fee schedule database (MPFSDB). [CR 11453]

Florida payment localities by county

Modified: 11/27/2020

Here is a listing of the counties comprising each payment locality in Florida.

Core-based statistical areas for Florida ASCs

Modified: 11/12/2020

Ambulatory Surgical Centers (ASCs) need to know their CBSA code in order to determine the correct fees.

Core-based statistical areas for Puerto Rico ASCs

Modified: 9/25/2020

Ambulatory Surgical Centers (ASCs) need to know their CBSA code in order to determine the correct fees.

First Coast Service Options (First Coast) strives to ensure that the information available on our provider website is accurate, detailed, and current. Therefore, this is a dynamic site and its content changes daily. It is best to access the site to ensure you have the most current information rather than printing articles or forms that may become obsolete without notice.