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Modifier 22: Getting Paid for Increased Procedural Services

Last Updated: June 19, 2026

Some surgeries take significantly longer or are vastly more complicated than usual due to patient anatomy or severe pathology. Modifier 22 (Increased Procedural Services) allows you to ask the payer for additional reimbursement beyond the standard fee schedule.

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Requirements for Modifier 22

Modifier 22 should never be used routinely. To get it paid, the work required must be substantially greater than typically required. Examples include:

  • Severe adhesions or scarring from previous surgeries.
  • Extreme obesity making the surgical approach exceptionally difficult.
  • Trauma resulting in massive anatomical distortion.

Medical Necessity: The Operative Report

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Appending Modifier 22 will almost always trigger a manual review by the payer. You MUST send the operative report. The surgeon should explicitly document a separate paragraph detailing why the procedure was unusually difficult and how much additional time it took.

NCCI and Fee Adjustments

Modifier 22 does not bypass NCCI edits (it is not an unbundling modifier like 59). It is strictly a pricing modifier. Ensure your base CPT codes are clean and unbundled before applying 22.

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