modifier 27

(2022) Modifier 27 – Description & Billing Guidelines

The CPT manual describes modifier 27 as “multiple outpatient hospital evaluation and management encounters on the same date.”

Usage Of Modifier 27

Use this modifier when a patient receives multiple E/M services performed by the same or different physicians in multiple outpatient hospital settings (e.g., emergency department, clinic, etc.)

Application Of Modifier 27

Modifier 27 should be appended only to E/M service codes within the range of CPT 92002-92014, CPT 99201-99499 and with HCPCS codes G0101 and G0175.

Hospitals may append modifier 27 to the second and subsequent E/M code when more than one E/M service is provided to indicate that the E/M service is “separate and distinct E/M encounter” from the service previously provided that same day in the same or different hospital outpatient setting.

When reporting modifier 27, report with condition code G0 when multiple medical visits occur on the same day in the same revenue centers.

Please Note

This modifier is not to be used by physician practices. It was created exclusively for hospital outpatient departments. However CMS does not require modifier 27. (CMS Reference)

The use of Modifier 27 must be substantiated in the patients medical record.

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