What is Level I or CPT Modifier in medical billing | Medical billing training in English

What are Level I and Level II Modifiers in Medical Billing | Medical Billing Training in Urdu

In medical billing, **Level I and Level II modifiers** are used to provide additional information about a service or procedure performed by a provider. These modifiers help ensure accurate billing and payment.

### **Level I Modifiers (CPT Modifiers):**

* These are **two-digit numeric modifiers**.
* They are part of the **CPT (Current Procedural Terminology)** coding system developed by the AMA.
* Used to indicate that a service or procedure has been altered in some way without changing its definition.

### **Level II Modifiers (HCPCS Modifiers):**

* These are **two-character modifiers** (alpha or alphanumeric).
* They are part of the **HCPCS (Healthcare Common Procedure Coding System)**.
* Often used to indicate items such as ambulance services, durable medical equipment, or specific anatomical sites.

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### **Two Practical Examples:**

#### **Example 1 – Level I Modifier (CPT Modifier 25):**

**Scenario:** A patient visits a physician for a scheduled physical, but during the visit also complains of a sore throat. The physician evaluates the sore throat separately.

* **Code Billed:** 99396 (Preventive visit)
* **Additional Code:** 99213-25 (Evaluation and management service with modifier 25 indicating it was a separately identifiable E/M service)
* **Purpose of Modifier 25:** Shows that the E/M service was distinct from the preventive visit.

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#### **Example 2 – Level II Modifier (HCPCS Modifier RT):**

**Scenario:** A patient receives a knee brace for the **right** knee.

* **Code Billed:** L1833 (Knee orthosis, adjustable)
* **With Modifier:** L1833 **RT**
* **Purpose of Modifier RT:** Specifies the **right** side of the body, helping the payer know which side the equipment was used on.

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