Modifier 22 Documentation Requirements
| Date: | July 12, 2022 |
| To: | HPSJ Providers & Facilities |
| From: | Health Plan of San Joaquin (HPSJ) |
| Subject: | Modifier 22 Documentation Requirements |
| Business: | Medi-Cal Managed Care |
The Department of Health Care Services (DHCS) guidelines state that when billing modifier 22, which indicates that a procedure was complicated, complex, difficult, or took significantly more time than usually required by the provider to complete, documentation must include a separate paragraph referencing Unusual Procedure to justify modifier 22.
As a reminder, documentation must support substantial additional work, including:
- Increased Intensity
- Time
- Technical difficulty of procedure
- Severity of patient’s condition
- Physical and mental effort required
Additional information can also be found on the Medi-Cal Website:
https://files.medi-cal.ca.gov/pubsdoco/publications/mastersmtp/part2/surgbilmod.pdf
Should you have any further questions, please contact our Customer Services Department at (209) 942‐6320. You may also visit https://www.hpsj.com/alerts/ for online access to the documents shared. The most recent information about Health Plan of San Joaquin and our services is always available on our website https://www.hpsj.com/.
If you have questions, please contact the Provider Services team at 1.888.936.PLAN (7526).