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Product Overview D-SNP
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Product Overview D-SNP
Anatomical modifier requirement policy
Last Updated on August 15, 2025
The policy applies to all Security Health Plan products and to all network and non-network physicians and other qualified health care professionals. It applies to services reported using:
- 1500 Health Insurance Claim Form (CMS-1500) or its electronic equivalent or its successor form
- UB-04 (CMS-1450) or its electronic equivalent or its successor form
According to the American Medical Association (AMA) CPT (Current Procedural Terminology) Manual and the HCPCS (Healthcare Common Procedure Coding System) Level II Manual, anatomic-specific modifiers designate the area or part of the body on which a procedure is performed. Use of laterality and/or anatomical modifiers add more information to the code to provide the highest specificity for the procedure being performed. In addition, they help to eliminate the appearance of duplicate billing and unbundling.
Based on AMA policy, anatomical modifiers are required whenever appropriate. If a procedure code in the list below is billed without a required anatomical modifier, it will be denied ANSI 16 “ Claim/service lacks information or has submission/billing error(s).” and Remark N822 “Missing procedure modifier(s).”
- Procedure codes in the range of 10000-69999 assigned a bilateral indicator of “1” on the National Physician Fee Schedule.
- Percutaneous coronary intervention (PCI), commonly known as coronary angioplasty or simply angioplasty, includes stent placement, atherectomy, and balloon angioplasty. There are five major coronary arteries (left main, left anterior descending, left circumflex, right, and ramus intermedius), each having a corresponding descriptive anatomical modifier. PCI codes are required be reported with one of the five anatomical PCI modifiers to be considered for reimbursement.
Anatomical/laterality modifiers include:
- E1-E4 (Eyelids)
- FA, F1-F9 (Fingers)
- TA, T1-T9 (Toes)
- LC (Left circumflex, coronary artery)
- LD (Left anterior descending coronary artery)
- LM (Left main coronary artery)
- RC (Right coronary artery)
- RI (Ramus intermedius)
- LT (Left side)
- RT (Right side)
- 50 (Bilateral)