QUEST Integration – Modifier Code 58

Original Effective Date:

12/01/2003

Current Effective Date:

01/01/2015

Modifier Code 58

Modifier code 58 is used to identify staged or related procedures performed by the same physician during the postoperative period.

Modifier 58 is used when:

• A procedure was planned prospectively at the time of the original surgery
• A procedure was more extensive than the original procedure
• A therapeutic procedure was done following a diagnostic procedure

Modifier 58 should not be used when the CPT code used already describes one or more sessions (e.g., 67101). The use of such a code would include all services rendered, regardless of the number of sessions, within the 90-day postoperative period.

Modifier 58 is not required by HMSA. The addition of modifier 58 is for informational purposes only. It has no effect on physician payment.

Example

A physician excises a breast lesion in the left breast on May 1 (CPT code 19125- LT). The pathology report indicates that the sample was positive for cancer and the physician performs a more extensive procedure on May 5, excising more breast tissue (CPT code 19160- LT, 58).

Revision History