Anatomic Modifiers

Append to a service that is performed on the hands, feet, eyelids, coronary artery or left and right side of the body.

Why we are requiring these modifiers?

These modifiers assist in identifying the highest level of specificity for coding of services along with reduce duplicate denials. Utilizing the most specific modifier(s) may also prevent denials associated with NCCI edit criteria, resulting in the decrease for medical record reviews and appeals.

Please note:

• Anatomical modifiers should not be utilized with modifier 50 (bilateral modifier) – please see our bilateral modifier web page for use of this modifier
• Anatomical modifiers should be utilized when the procedure or service is performed unilaterally to identify additional services rendered (reflects services are not duplicates)
• Reporting an anatomical modifier for procedures such as skin lesions or anatomical sites not specific to a body region may result in denials
• Modifiers 59, XU, XS, XP, XE should not be utilized in place of an anatomical modifier – please code with the most specific modifiers
• Anatomic modifiers should align with any ICD-10 diagnosis codes that designates laterality (ie. Diagnosis is for RT leg, anatomic modifier should also indicate RT leg); Diagnosis codes to the highest level of specificity
• Reporting an anatomical modifier with an unspecific lateral diagnosis code (diagnosis has specific RT, LT, or bilateral diagnosis codes) may result in denials.
• Services with anatomic modifiers are subject to the multiple procedure reductions (when applicable). Get more information

Anatomical modifiers

Clinical edit: Anatomical Modifiers Use Max Frequency

Claims will deny excess units when any provider bills more than one unit of service with an anatomical modifier E1-E4 (Eyes), FA-F9 (Fingers), and TA-T9 (Toes).

Anatomical modifiers of E1-E4, FA-F9, TA-T9 have a maximum allowable of one unit per anatomical site for a given date of service. Any service billed with an anatomical modifier for more than one unit of service will be adjusted accordingly.

Modifier 99 – Multiple modifiers

For services that require more than four modifiers, report modifier 99 in the first modifier position. The other specific anatomical location modifiers should be listed in item 19 on the claim form.