NOTE: A copy of the operative report is required.
| Modifier Code | Description | Documentation Required |
|---|---|---|
| Modifier Code 22 | Prolonged E/M services | Clinical notes |
| Modifier Code 22 | Unusual procedural services | Clinical notes |
| Modifier Code 62 | Two surgeons | Clinical notes |
| Modifier Codes 78 and 79 | Return to the operating room for a related procedure during the postoperative period | Clinical notes |
| Modifier Codes 78 and 79 | Unrelated procedure or service by the same physician during the postoperative period | Clinical notes |
In addition, HMSA may require submission of clinical records before or after payment of claims for the purpose of investigating potential fraudulent, abusive or other inappropriate billing practices, but only as long as there is a reasonable basis for believing such investigation is warranted.
Revision History
| Date | Nature of Revision |
|---|---|
| 08/03/2026 | Migrated to new platform. |