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How do I add modifiers to my claims?

You now have the option to add modifiers to your claim forms and superbills automatically. You can also choose to add modifiers by manually editing a claim. In this guide, we'll cover: 


Turning on modifiers in your account

To turn on the modifiers feature in your account, follow these steps: 

  • Go to My Account > Settings > Billing and Services > Insurance
  • Check the Enable modifiers for your practice box
    enablemodifiers.simplepractice.billingandservices.jpg
  • Click Save

You will now be able to add modifiers to appointments so they display on claim forms automatically. 


Adding modifiers from the calendar for individual appointments

If you have specific appointments you want to add modifiers to, you can add them from the calendar. This option is great if you don't typically add a modifier for a particular client's appointments, but you have a one-off need. 

To add a modifier to an appointment, follow these steps:

  • Go to the Calendar homepage and click the appointment
  • Enter the modifier in the modifier field
    addmodifier.simplepractice.calendar.jpg

Note: You can add up to 4 modifiers per service code. 

  • Click Done to save your changes

Modifiers you add from the calendar will only apply to the appointment(s) you've edited. If the appointment you edit is part of a recurring series, you'll have the option to add the modifier to all future appointments in the series as well. 


Setting a default service code and modifier for a client

You have the option to set a default service code and modifier for a client so that all of their appointments moving forward include the modifier. You'll still have the opportunity to make edits to individual appointments if you'd like. This option is great if you typically see a client for the same service that requires a modifier. 

To add a modifier to a default service code, follow these steps: 

  • Go to the client's Overview page > Edit > Billing and Insurance
  • Select a default Service Code from the dropdown and enter a Rate Per Unit
  • Enter a modifier(s) in the Modifiers field defaultmodifier.simplepractice.billingandinsurance.jpg
  • Click Save Client when you're done

Note: Keep in mind that team members with the Biller role will be able to view and edit modifiers from both the Calendar and the client's Billing and Insurance settings. Schedulers will only be able to view and edit modifiers from the Calendar. 

ImportantThis feature will not be available for appointments that are requested through the Client Portal. In these cases, modifiers will need to be manually added to your claims.


Using modifiers in the SimplePractice mobile app

You can add modifiers to appointments from the Calendar through the iOS and Android mobile apps, as long as the modifiers feature has been enabled for your practice through the web app. 

After the feature is enabled in your account, you can open your mobile app and follow these steps: 

iOS: 

  • Navigate to the Calendar tab and select an appointment
  • Tap Edit > Billing > Modifiers
  • Enter your modifier(s) 
  • Tap the back arrow
  • Tap Save

Android: 

  • Navigate to the Calendar tab and select an appointment
  • Tap Edit > Billing > Modifiers 
  • Enter your modifier(s) 
  • Tap the checkmark at the upper right 
  • Tap the back arrow 
  • Tap the checkmark at the upper right to save all changes

Note: See Getting started with the SimplePractice mobile app to learn how to use the different features included in the SimplePractice mobile app. 


Modifiers on claim forms and superbills

When a modifier is added to a service for an appointment, it will get included automatically on claim forms and superbills for that appointment. 

On claim forms, the modifier will populate onto box 24D and will appear like this: 

claimform.simplepractice.modifiers.jpg

On superbills, the modifier will populate in the Service field after the service code: 

superbills.simplepractice.modifiers.jpg


Manually adding modifiers to claim forms and superbills

You can also manually add modifiers to your insurance claims and superbills in SimplePractice.

To add manually a modifier to a claim form:

  • Navigate to the client's Billing page 
  • Create a claim for the Telehealth appointment
  • Enter the Telehealth modifier manually into box 24D of the claim form  
  • Click Save or Submit 

Manually add modifiers to insurance claims on box 24D of the claim form in SimplePractice

To manually add a modifier to a superbill, you will need to create a custom service code:

  • Navigate to My Account > Settings > Billing and Services > Services
  • Click Add New Service 
  • Enter your custom service code with the modifier
    • For example, to add the Telehealth modifier to 90834, create code 90834-95
  • Enter the Description, Rate, Default Service Duration, and Booking Options
  • Click Save

Modifiers for Telehealth appointments

There are two different modifiers that can be used when billing a Telehealth appointment.

  • If you're billing a commercial insurance payer, the modifier should be 95
  • If you're billing Medicare, the modifier should be GT

If you enable the automatic modifiers feature in your account, you can add the appropriate Telehealth modifier to individual appointments on the Calendar, or as part of a client's default service. 

Note: Modifiers can vary based on service location, even when the same CPT code is being used. Be sure to double check that the appropriate modifier is listed based off of the services provided.

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