Which modifier indicates the service was required by a third-party payer or regulatory body?

Prepare for the Mobius Institute Board of Certification (MIBoC) Exam. Utilize flashcards and multiple choice questions each with hints and detailed explanations. Equip yourself with the knowledge to excel in your certification!

The correct modifier that indicates a service was required by a third-party payer or regulatory body is the -32 modifier. This specific modifier is used to signify that a service was mandated or authorized by an outside source, such as an insurance company, government entity, or another regulatory body. By applying the -32 modifier, healthcare providers can communicate to payers that the procedure or service was not merely elective but rather a necessary action requested under certain conditions, ensuring that the claim is processed accurately according to the requirements set by the payer.

The other modifiers serve different purposes:

  • Modifier -51 is used to indicate multiple procedures performed during the same session and does not relate to third-party requirements.

  • Modifier -24 is used for reporting an unrelated evaluation and management service during the postoperative period, which does not pertain to the necessity of the service by a third party.

  • Modifier -26 indicates professional components of a service, focusing on the interpretation or analysis rather than the necessity enforced by an external authority.

Understanding the specific use of modifiers like -32 is crucial for proper billing and coding, as it helps ensure compliance with payer requirements.

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