GoodX Manage for Medical | Dental Practices

0004 - Procedures performed in own procedure rooms: 

Procedures performed in a practitioner's own procedure room instead of in a hospital theatre or unattached theatre unit: as per fee for procedure + 100% (the value of modifier 0004 equals 100% of the value of the procedure performed). See Section G for a list of procedures, which are often done in rooms to which Modifier 0004 should not be applied. Please note: Only the medical practitioner who owns the facility and the equipment may charge modifier 0004. Only one person may claim this modifier for procedures performed in doctors' own procedure rooms

So the practitioner is entitled to 100% of the clinical producer's price because he takes up the risk of doing it in his own procedure room.

The modifier calculates 100% of a unit type 2 producer code. Note that it as AM (Plus modifier).

0005 - Multiple therapeutic procedures/operations under the same anaesthetic:

a) Unless otherwise identified in the tariff when multiple therapeutic procedures/operations add significant time and/or complexity, and when each procedure/operation is clearly identified and defined, the following values shall prevail:  100% (full value) for the first or major procedure/operation, 75% for the second procedure/operation, 50% for the third procedure/operation, 25% for the fourth and subsequent procedures/operations. This modifier does not apply to purely diagnostic procedures.

b) In the case of multiple fractures and/or dislocations the above values shall prevail.

c) When purely diagnostic endoscopic procedures or diagnostic endoscopic procedures unrelated to any therapeutic procedures performed, are performed under the same general anaesthetic, Modifier 0005 is not applicable to the fees for such diagnostic endoscopic procedures as the fees for endoscopic procedures do not provide for after-care. Specify unrelated endoscopic procedure and provide diagnosis to indicate diagnostic endoscopic procedure(s) unrelated to other (therapeutic) procedures performed under the same anaesthetic.

d) Please note:  When more than one small procedure is performed and the tariff makes provision for items for "subsequent" or "maximum for multiple additional procedures" (see Section 2. Integumentary System) Modifier 0005 is not applicable as the fee is already a reduced fee.

e) “+” Means that this item is used in addition to another definitive procedure and is therefore not subject to reduction according to Modifier 0005 (see also Modifier 0082)

The following codes are used in this example:

After the codes are billed the 0005 can be applied.

The 0005 will modify unit type 2 procedures. Note that it is an RM (Minus modifier).