Common Questions About Billing Modifiers
Published: October 01, 2025
Last updated: October 01, 2025
For the full in-depth guide, see the Ambiki Billing Modifier Guide. Below are answers to some of the most common questions practices have about billing modifiers in Ambiki.
What is a billing modifier and why does it matter?
A modifier is a two-character code added to a procedure code to provide additional information about the service performed. Even though they are short, modifiers have a big impact. Missing or incorrect modifiers can lead to claim denials, delayed payments, and unnecessary administrative work. Correct modifier use ensures that payers understand the circumstances of the service and process your claims smoothly.
Where can modifiers be added in Ambiki?
Modifiers can come from multiple sources in Ambiki, and all applicable modifiers are combined automatically (with duplicates removed):
- Pre-configured billing codes: Complete codes that already include modifiers.
- Service rates: Default rates that can include modifiers, sometimes tied to location.
- Payer-specific service rates: Custom rates for a specific insurance company.
- Patient payment methods: Modifiers tied to a patient’s plan, location, or discipline.
- Treatment reports: Manually added modifiers that apply to all invoices for a given session.
What are the most common modifiers used?
Some of the most frequently encountered modifiers include:
- 59: Distinct procedural service (for multiple procedures in one session).
- 95 / GT: Telehealth services (different payers may require different ones).
- GN / GO / GP: Services under SLP, OT, or PT plans of care.
- 96 / 97: Habilitative vs. rehabilitative services.
- UB: Services provided by an assistant.
How do modifiers combine in Ambiki?
Unlike systems that use strict overrides, Ambiki collects modifiers from every applicable source. For example:
- A payer-specific rate might add GN
- A patient’s plan might add 95 for teletherapy
- That same plan might also require 96
The final billing code could look like: 92507 + GN + 95 + 96.
When should I add modifiers at the treatment report level?
Use treatment reports if the modifier applies to all payers for that specific session. For example, if a co-treatment scenario requires a modifier across the board. Avoid adding payer-specific modifiers here since they will be applied universally, which can lead to claim errors.
How do location-based modifiers work?
Modifiers based on location can be added in three ways, depending on how broad or narrow the requirement is:
- Service rate – If all payers require the same location modifier.
- Payer-specific rate – If only one insurance company requires it.
- Patient payment method – If only certain patients under a plan require it.
How do I handle multiple services in one session?
If more than one procedure is billed in the same session, the second and subsequent procedures typically require modifier 59. Best practice is to create pre-configured billing codes (e.g., “92526-59 Feeding therapy when billed with speech therapy”) to avoid mistakes and ensure staff consistency.
How does Ambiki handle assistants, clinical fellows, and students?
- Assistants and CFs: Ambiki automatically applies supervisor NPI details, but you may need to add assistant-specific modifiers (like UB) using pre-configured billing codes.
- Clinical Fellows: If licensed, CFs can sometimes bill under their own NPI (requires setup by Ambiki support).
- Students: Claims will use the supervisor’s NPI and taxonomy.
What are best practices to reduce modifier errors?
- Use pre-configured billing codes for common scenarios.
- Minimize manual entry by training staff to pick the right billing code, not add modifiers manually.
- Review payer-specific requirements regularly, since rules can change.
- Document your clinic’s modifier rules for quick reference.
What should I do if a claim is denied due to missing or incorrect modifiers?
- Check if the modifier was added at the right level (service rate, payer-specific rate, patient method, or treatment report).
- Verify payer-specific rules.
- Review the claim preview to confirm modifiers are being applied.
- Adjust configurations if the error stems from a mismatch between payer requirements and your setup.
Quick Decision Guide
- Treatment Report: Use if it applies to all payers for a session.
- Pre-configured code: Use for scenarios you encounter regularly.
- Payer-specific config: Use if only one insurer requires it.
-
Patient payment method: Use for very specific, patient-level requirements.
By understanding how Ambiki combines modifiers from multiple sources and by setting them up thoughtfully, you can prevent claim denials, save time, and ensure accurate billing. For detailed walkthroughs and examples, check out the full Billing Modifier Guide.
Kevin Dias