Modifier Code 22

Procedural services

Modifier code 22 is used to show extraordinary circumstances for non-routine surgical or procedural services. The use of modifier code 22 may result in increased payment if:

• Documentation is submitted that supports the medical appropriateness of the expanded services and
• A concise statement is included with the claim explaining how the service differs from the usual procedure and why the practitioner views the service to be significantly greater than the norm.

Radiology

When the complexity of services for radiology exceeds what is usually required for the listed procedure, it may be identified by adding modifier code 22 to the usual procedure number. Modifier code 22 also may be used with computerized tomography procedure codes when additional slices are required or a more detailed examination is necessary.

Other medical services, anesthesia, surgery, pathology and laboratory

When the complexity of services for these categories exceeds that usually required for a listed procedure, it may be identified by adding modifier code 22 to the usual procedure code. A report may be appropriate as well.

Claims Filing Information

When using modifier code 22, include the appropriate CPT code in Block 24D of the CMS 1500 claim form. To indicate an extraordinary service, enter 22 to the right of the procedure code. Be sure to include any necessary supporting documentation (e.g., office notes) with your claim submission.

To avoid unnecessary delays in processing and payment, modifier code 22 should not be used to report lower-level services.

Revision History