A Modifier is a code that allows the Practitioner to indicate that a service or Procedure has been altered by a specific circumstance without changing the Procedure’s definition or code. The Practitioner will bill the Modifier code and apply it to the applicable Procedure codes. Modifiers provide additional information about the Procedure that may affect how it is billed, such as changes in units, value, or timing. They ensure that billing accurately reflects the service performed, supports correct reimbursement, complies with NHRPL/SAMA Rules, and creates a clear audit trail of special circumstances.

• Different Modifiers are used based on the circumstances of the Procedure, for example:
  • Time-Based Modifier: Applied when a Procedure is billed according to duration. Time-based Modifiers specify the allocated time for the initial service and any additional time units required.
  • Multiple Procedure Modifier: Used when more than one Procedure is performed during the same session. It clarifies that additional Procedures must be billed at reduced or adjusted tariffs, as per the NHRPL Rules.
  • Extended Service Modifier: Indicating that a Procedure required more time, skill, or resources than usual. This Modifier increases the total value of the Procedure as defined by the NHRPL guidelines.
  • Assistant Modifier: Applied when an assistant Practitioner is required for a Procedure or surgical event. It ensures that the assistant’s portion of the fee is billed correctly.
  • Anaesthetic Modifier: Used to specify the type of anaesthesia provided and who administered it. It adjusts the value of the Procedure based on the anaesthetic circumstances.
  • After-Hours Modifier: Applied when services are rendered outside normal consulting hours. It allows for correct billing of weekday after-hours, weekends, and public holidays.
  • Emergency Modifier: Indicating that the service was rendered under emergency circumstances. It allows for adjusted billing due to the urgency and additional resources required.
  • Materials Modifier: Used when high-value materials, consumables, or specialised items were used during a Procedure. It adjusts the billing to include the cost of these items.
  • Dispensing Modifier: Applied when items or medication are dispensed directly to the Patient. It ensures that the appropriate dispensing fee is included.
  • Repeated Procedure Modifier: Used when the same Procedure is performed more than once on the same day for the same Patient. It clarifies that the repeated service is clinically justified.