Modifier 32

When is Modifier 32 used?

Modifier 32 is used to indicate that services provided are related to mandated consultation and/or related services. This modifier is used to ensure proper documentation and billing for services that are required by external mandates, such as government regulations or other authoritative bodies. When using Modifier 32, healthcare providers are able to clearly communicate that the services rendered are a result of specific mandates, ensuring transparency and accuracy in billing processes.

Modifier 32 is used to indicate that mandated services have been provided as required by a third-party payer or regulatory body. This modifier is important for ensuring proper reimbursement for services that are mandated by external entities.

When submitting claims with Modifier 32, healthcare providers must clearly document the reason for the mandated service and provide any necessary supporting documentation to justify the use of the modifier.

Key concepts of modifier 32

• Modifier 32 is a specific coding guideline used in healthcare billing for mandated consultation and related services. It is important to note that Modifier 32 should only be applied when a service is mandated by a third-party entity, such as an insurer or an official organization like Worker’s Compensation.
• It should not be utilized for seeking a second opinion from a different physician, regardless of whether it is requested by the patient, a family member, or another healthcare provider.
• The primary purpose of Modifier 32 is to facilitate situations where a service is required by a specific entity for reasons such as independent evaluation of a claim report or obtaining a second opinion on a patient’s condition before initiating treatment or testing.
• It is crucial to adhere to the guidelines and avoid using Modifier 32 for scenarios involving general consultations between physicians, patient evaluations for medical clearance, or any situation where Medicare is involved, as Medicare does not recognize or reimburse services billed with Modifier 32.

Examples of modifier 32

Modifier 32 is used to indicate mandated services related to consultation or other related services that are required by a third-party payer, governmental agency, or other regulatory body. Below are examples showcasing scenarios where Modifier 32 may be applicable:

Example 1: A patient with a complex medical condition is receiving treatment at a hospital. The hospital is required by Medicare to provide additional consultations by specialists in order to determine the most appropriate course of action. In this case, the consultations provided by the specialists would be billed with Modifier 32 to indicate they are mandated services related to the patient’s treatment.

Example 2: A child with special needs requires speech therapy services as mandated by their Individualized Education Program (IEP) outlined by the school district. The speech therapy sessions would be billed with Modifier 32 to signify that they are required services as part of the child’s educational plan.

Example 3: An individual involved in a personal injury lawsuit requires psychological evaluations as mandated by the court for the purpose of determining damages. The psychological evaluations would be billed with Modifier 32 to indicate that they are services related to the legal mandate.