Modifier Percentage

The Modifier Percentage tool lets you apply modifier reductions to line items that have been repriced by another reimbursement tool, that is, a line item whose resources have been consumed. If the line item’s resources have not been consumed, it does not qualify for the reductions applied by the Modifier Percentage tool.

You can add one or more modifier tables to this tool and add a procedure lookup table for each modifier table. You can also choose to virtually adjust Modifier 50 (Bilateral) procedures to ensure that these modifiers are priced correctly.

• If you select a modifier table in the Modifier Table column and then select a procedure lookup table in the Apply To column, the code on the claim must match both the modifier and procedure lookup tables to qualify for the modifier reduction.
• If you select a modifier table in the Modifier Table column and leave the Apply To column blank, the code on the claim must match only the modifier table to qualify for the modifier reduction.
• A procedure code matches an entry in a lookup table according to standard matching rules. For more information, refer to Reimbursement Tools.
• To select an additional Modifier Table, click the Plus (+) sign to add an additional modifier table line.
• To delete a modifier table line, click the Minus (-) sign next to the line.
• Selecting the Virtually Adjust Modifier 50 check box automatically accounts for the various ways that bilateral procedures can be billed and ensures that these procedures are repriced correctly, regardless of the billing method on the claim.
• Selecting the Apply bilateral proc rules to LT/RT codes check box applies bilateral procedures to codes with LT or RT modifiers.