Beginning with claims submitted on or after May 1, 2018, care providers will be required to include an anatomical modifier that identifies the area or part of the body for procedures performed on the eyelids, fingers or toes. This coding edit is consistent with Centers for Medicare & Medicaid Services (CMS) correct coding guidance and will be addressed in UnitedHealthcare’s Procedure to Modifier Policy. The corresponding anatomical modifier requirement will be applicable as additional procedure codes and/or modifiers are created.
Eyelid, finger and toe procedure codes reported without the modifier will be denied. Services will be denied and claims can be resubmitted with the appropriate modifier. Please refer to United Healthcare’s administrative guides for claim correction and resubmission information. A sampling of procedure codes and required modifiers is provided in the following table:
Procedure code | Procedure description | Modifier code | Modifier description |
67850 | Treat eyelid lesion | E2 | Lower left, eyelid |
26951 | Amputation of finger/thumb | F1 | Left hand, second digit |
28510 | Treatment of toe fracture | T8 | Right foot, fourth digit |
For your reference, here is a list of all applicable anatomical modifiers:
E1 Upper left, eyelid F9 Right hand, fifth digit
E2 Lower left, eyelid FA Left hand, thumb
E3 Upper right, eyelid T1 Left foot, second digit
E4 Lower right, eyelid T2 Left foot, third digit
F1 Left hand, second digit T3 Left foot, fourth digit
F2 Left hand, third digit T4 Left foot, fifth digit
F3 Left hand, fourth digit T5 Right foot, great toe
F4 Left hand, fifth digit T6 Right foot, second digit
F5 Right hand, thumb T7 Right foot, third digit
F6 Right hand, second digit T8 Right foot, fourth digit
F7 Right hand, third digit T9 Right foot, fifth digit
F8 Right hand, fourth digit TA Left foot, great toe