CPT Modifier 32 Usage and Reimbursement

Modifier 32 should be used when services related to mandated consultation and / or related services such as confirmatory consultations and related diagnostic service (eg. third party payer, governmental, legislative or regulatory requirement) may be identified by adding modifier 32 to the basic procedure. The use of modifier 32 is not appropriate when the patient, family members or other parties request second opinions or other services. A common circumstance in which this modifier might be appropriately used is when a workers’ compensation carrier asking for a second opinion sends a patient to a provider.

In some circumstances when children in state custody are sent to physician office for health examinations after being placed in temporary custody or foster care.

Do we need to report Modifier 32 for immunizations?

No. Modifier -32 are never to be used for services related to immunizations

Please note:

The CPT modifier -32 (Mandated Services) is not recognized as a payment modifier in Medicare. A second opinion evaluation service to satisfy a requirement for a third party payer is not a covered service in Medicare.

The payer may also waive deductibles or co-payments; however, not all payers cover services when they are mandated, and often expect the government agency to pay for the service (e.g., an examination to determine abuse/rape).

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