Quick Tips

  • Hospital ASC and Outpatient Coders

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.

  • Do not bombard the Medicare contractor or other third-party payer with unnecessary  documentation. All attachments to the claim for justification of the unusual services

should explain the unusual circumstances in a concise, clear manner. The information for the
justification of unusual services should be easy to locate within the attached documentation. Highlight this information, if necessary, to facilitate the medical reviewer’s access to the pertinent supporting data.

Key points :

Claims submitted to Medicare, Medicaid, and other third-party payers containing modifier 22 for
unusual procedural services that do not have attached supporting documentation that illustrates the unusual distinction of the services will generally be processed as if the procedure codes were not appended with this modifier. Some third-party payers might suspend the claims and request additional information from the provider, but this is the exception rather than the rule.