Anatomical modifiers

Beginning with claims processing on or after August 1, 2024, Anthem will use coding policies to support the use of anatomical modifiers. These policies were developed to promote national correct coding methods and to control improper coding that leads to incorrect payment. This update is part of continuing efforts to process claims accurately without having to request additional documentation from care providers.

What are the policies for using anatomical modifiers in procedure coding?

CPT^® and HCPCS Level II guidelines supporting the use of anatomic-specific modifiers were used to develop these policies, which validate the area or part of the body on which a procedure is performed. Procedure codes that do not specify right or left require the appropriate anatomical modifier. If an anatomical modifier is necessary to differentiate right or left and is not appended, the claim will be denied. Likewise, if a modifier is appended to a procedure code that does not match the appropriate anatomical site, the claim will be denied.

Action needed

CPT and HCPCS Level II guidelines support the following set of anatomical modifiers to facilitate correct coding for claims processing. Care providers are encouraged to follow these guidelines and append the modifiers relevant to the procedure code on the service line.

The anatomical modifiers, which must be reported, are:

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