Modifier 22
CPT modifier indicating increased procedural services requiring substantially greater work than usually required.
1 min read · Last reviewed May 23, 2026
At a glance
- Category
- Billing
- Primary sources
- 1
- Workspace handoff
- denial workbench →
Where this comes up
This shows up in revenue-cycle work — claim scrubbing, charge entry, posting, A/R follow-up, and month-end close. Billers and practice managers hit this term when reconciling a payment, working a denial queue, or auditing why a claim aged past 60 days.
Full definition
What it is in practice
CMS recognizes modifier 22 with documentation of the additional work. Payers typically pend the claim for medical-record review.
How it shows up in your practice
Use modifier 22 sparingly. Document the increased complexity precisely — duration, blood loss, complicating factors. Submit a cover letter when appealing reduced payment.
Sources
- CMS — Modifiershttps://www.cms.gov/medicare/coding-billing/modifiers
Defend modifier-22 reductions in the Denial Workbench
Open denial workbench →Related terms
- CodingMedical NecessityThe standard requiring that services be reasonable and necessary for the diagnosis or treatment of illness or injury or to improve the functioning of a malformed body member.
- Denials & AppealsAppeal LetterThe written request to a payer to reconsider a denied or partially-paid claim.
D3rx is a healthcare-billing and compliance research aid maintained by D3rx Inc. Articles are drafted by an LLM (Anthropic Claude) against primary HHS, OCR, CMS, eCFR, NIST, and state-regulator publications, and reviewed for restraint and source fidelity by the D3rx team.
Reviewer status: a named credentialed reviewer (CHC, CHPC, or healthcare attorney) is being engaged. Until that engagement is finalized, this page does not claim credentialed review.
Related across the archive
- GlossaryAppeal LetterThe written request to a payer to reconsider a denied or partially-paid claim.
- GlossaryMedical NecessityThe standard requiring that services be reasonable and necessary for the diagnosis or treatment of illness or injury or to improve the functioning of a malformed body member.
- GlossaryModifier 24CPT modifier indicating an unrelated E/M service performed by the same provider during a postoperative global period.
- GlossaryModifier 26CPT modifier indicating the professional component of a procedure.
- GlossaryModifier 50CPT modifier indicating a bilateral procedure performed at the same operative session.
- GlossaryModifier 51CPT modifier indicating multiple procedures performed at the same session by the same provider.
- GlossaryModifier 57CPT modifier indicating an E/M service that resulted in the initial decision to perform major surgery.
- BillingAWV + Problem Visit Same Day: How to Bill CorrectlyYes, you can bill AWV and a problem visit the same day. Here's how to do it correctly with modifier -25.
This glossary entry is a research aid for billing and compliance staff. It does not provide legal, medical, or financial advice and does not replace counsel. References cited link to primary sources at HHS, OCR, CMS, eCFR, NIST, and the relevant payer or industry body.