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modifier 22 is a representation by the provider that the treatment rendered on the date of. services was substantially greater than usually required. The use of modifier 22 does not. guarantee additional reimbursement.
Modifier 22 isn't a free pass to additional reimbursement. Payers need detailed evidence of the extra difficulty encountered in comparison to the work that would normally be expected for the procedure performed. They won't hand out extra payment when they see modifier 22 \u2013 you have to request it.
Medical director review will determine if requirements are met for an additional allowance for modifier 22. b. If the review determines that an additional allowance is warranted, the procedure will be reimbursed at 125% of the normal allowance (contracted fee or maximum plan allowable).
Modifier 22 is not applicable in hospital ASC or hospital outpatient facilities in accordance with CPT modifiers approved for ambulatory surgery center (ASC) outpatient hospital use.
Surgical procedures that require additional physician work due to complications or medical emergencies may warrant the use of modifier 22 after the surgical procedure code. Modifier 22 is applied to any code of a multiple procedure claim, whether or not that code is the primary or secondary procedure.
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Modifier 22 is defined as "Increased Procedural Services: When the work required to provide a service is substantially greater than typically required, it may be identified by adding modifier 22 to the usual procedure code.
MODIFIER 22-UNUSUAL PROCEDURAL SERVICES The operative report should be attached to the claim. Payment is usually 20-30% higher. Often, reimbursement will not be increased when the EOMB is returned. Often, this means that the documentation was insufficient to support increased time and effort.
Surgical procedures that require additional physician work due to complications or medical emergencies may warrant the use of modifier 22 after the surgical procedure code. Modifier 22 is applied to any code of a multiple procedure claim, whether or not that code is the primary or secondary procedure.

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