Modifier 32 | Mandated Services

Modifier 32 describes an informational modifier used in medical billing and coding to indicate that a third-party payer or governmental, legislative, or regulatory requirement mandated a service. It is appended to the basic procedure code to identify required services, such as consultations or services required by a third party.

1. What is modifier 32?

Modifier 32 is an informational modifier used to indicate that a third party mandated the performance of a service. It is used to identify required services, such as those required by a third-party payer, governmental, legislative, or regulatory requirements. Modifier 32 is appended to the CPT code to indicate that the service was mandated.

2. When to use the 32 modifier?

Modifier 32 should be used when a third-party payer, governmental, legislative, or regulatory requirement mandates a service.

For example, a patient’s disability or worker’s compensation insurance may mandate a service, such as a consultation, because the insurance is disputing an injury claim and wants more information.

Under certain circumstances, some third–party payers may require a patient to undergo certain mandated services, such as obtaining second or third opinions, before undergoing a procedure and/or therapeutic service.

When a patient is scheduled for this type of mandated service, report the procedure CPT code and append modifier 32.

3. Description

The official description of modifier 32 is “mandated services.”

4. Examples

Examples of procedures that require modifier 32 include mandated consultations, confirmatory consultations, and other services required by a third-party payer, governmental, legislative, or regulatory requirements.

For example, a patient’s disability or worker’s compensation insurance may mandate a service, such as a consultation, because the insurance is disputing an injury claim and wants more information.

Under certain circumstances, some third–party payers may require a patient to undergo certain mandated services, such as obtaining second or third opinions, before undergoing a procedure and/or therapeutic service.

5. Documentation

Documentation requirements for modifier 32 include documentation of the mandate from the third-party payer, governmental, legislative, or regulatory requirement.

The documentation should include the name of the entity mandating the service, the reason for the mandate, and any other relevant information.

6. Billing

To bill for a service that requires modifier 32, report the procedure code and append modifier 32 to indicate that the service was mandated. The service should be billed according to the usual billing guidelines for the procedure code.

7. Common mistakes

Medical coders make common mistakes when using modifier 32, including failing to document the mandate from the third-party payer, governmental, legislative, or regulatory requirement, and failing to append the modifier to the procedure code.

To avoid these mistakes, coders should ensure they have all the necessary documentation and follow the appropriate billing guidelines.

8. Other modifiers related to modifier 32

Other modifiers related to modifier 32 include modifier 33, used to indicate preventive services, and modifier 59, used to indicate a distinct procedural service.

9. Tips

When using modifier 32, it is important to ensure that all necessary documentation is in order and that the modifier is appended to the procedure code.

Coders should also be aware of other modifiers related to modifier 32 and how they are used.

10. Conclusion

Modifier 32 is an informational modifier that indicates that a third-party payer, a governmental, legislative, or regulatory requirement mandated a service.

Medical coders need to understand when to use this modifier, how to document its use, and how to bill for required services. By following the appropriate guidelines and avoiding common mistakes, coders can ensure accurate and efficient medical billing and coding.