Anatomic modifiers required starting Apr. 1, 2022

Following the American Medical Association’s CPT coding guidelines, we’ll require appropriate anatomic modifier codes on claims starting Apr. 1, 2022. We’ll implement a new clinical edit, which will apply to all claims. If you’d like to see how this applies to a sample claim, try our online Edits Checker tool.

These modifiers supply more information that includes site or side of the body a procedure was performed and meets the highest level of specificity in coding.

By using these anatomical modifiers, you can:

• Help ensure prompt and accurate claims adjudication and payment
• Reduce duplicate denials
• Decrease the need for medical reviews and appeals

For more details on anatomic modifiers and a complete list of modifiers for services performed on the hands, feet, eyelids, coronary artery or left and right side of the body, see the anatomic modifiers page in our Provider Manual.