Variable: IDR-MOD-ONE

First Procedure Code Modifier

Source System Definition

This is first procedure modifier. In addition to the normal pricing criteria, the system allows claims examiners to use modifier codes to further qualify billed procedures. In some cases, the modifier requires special handling for pricing the service; in other cases, the modifier is used for further documentation of the performed service.

The two types of modifiers, as referred to in the MCS, are statistical and pricing. There are two types of statistical modifiers. Some statistical modifiers are documentation modifiers and do not affect pricing although they may affect processing. Other statistical modifiers affect pricing by causing the established reasonable charge or fee to be modified in the same way every time. In both cases, statistical modifiers are not established on the procedure or pricing files as part of the procedure code key. On the other hand, pricing modifiers are considered by the system as part of the seven-digit procedure code key and are used for obtaining established reasonable charge or fee amounts. The reasonable charge or fee amounts for procedure codes with pricing modifiers are established independently of the same procedure without the modifier.

This field may contain multiple procedure code modifiers or spaces. A procedure code modifier will further define the procedure code as a unique and different service/supply.

Other Info

• Source System: MCS
• Source Field: First Procedure Code Modifier
• Version: 0.2