What would happen if a modifier was incorrectly applied to a CPT code?

When a modifier is incorrectly applied to a CPT code, it can significantly affect the claims process, leading to potential delays or even denials of reimbursement. Modifiers provide additional information about the performed service or procedure, such as indicating whether it was performed bilaterally, whether it involved multiple sessions, or if it was a distinct procedure performed on the same day. If a modifier is misapplied, the insurance provider may question the validity of the claim or the necessity of the service, which can result in a thorough review or rejection of the claim altogether. Correct documentation and the appropriate use of modifiers are crucial for ensuring that claims are processed efficiently and reimbursements are received in a timely manner.