decisionhealth Newsletters, Part B News - 2025 Issue 1 (January)
Modifiers 24, 25 not denied much — but watch for danger zones
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Article Overview
This premium article examines 2023 claims trends for operation-related evaluation and management modifiers and compares denial rates across specialties. It is aimed at coding professionals, practice managers, and reimbursement analysts who want a high-level view of how these modifiers performed in real-world claims data and where denial risk clustered. The discussion focuses on usage patterns, specialty differences, and selected code-level examples that illustrate problem areas without serving as a full coding reference.
Why This Topic Matters
Understanding how these modifiers perform in claims data can help readers identify specialty-specific denial risk and monitor utilization patterns. The article is useful for organizations looking to benchmark their billing behavior against broader claim trends.
Article Sections
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Benchmark of the week
Introduces the article’s claim-volume and denial-rate benchmark for operation-related modifiers and frames the comparison across specialties and services.
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Denial rates and specialty patterns
Summarizes overall denial performance and highlights how usage and denial patterns vary among specialty groups.
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Selected code-level outliers
Discusses a few claim scenarios that stood out as especially problematic or unusually successful, including specialty-specific examples.
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Modifier 57, top 10 specialties, 2023, with denial rates
Presents a specialty-focused view of claims involving one of the operation-related modifiers and its 2023 denial pattern.
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Modifier 24, top 10 specialties, 2023, with denial rates
Presents a specialty-focused view of claims involving the other operation-related modifier and its 2023 denial pattern.
What You Will Learn
- How recent claim-volume trends changed for operation-related modifiers
- How denial rates compare across specialties
- Which broad specialty groups appear more vulnerable to denials
- What kinds of claim patterns the article highlights as potential risk areas
Who Should Read This
- Medical coders
- Billing staff
- Revenue cycle professionals
- Practice managers
- Compliance teams
- Reimbursement analysts
Codes Discussed
Modifiers Discussed
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