have one procedure code modify another to be paid

have one procedure code modify another to be paid at a lower percentage

Currently you can create bilateral codes such that the second side pays at a lower percentage. Ideally, this could be expanded so that if I bill a visit code with a phone modifier code, the phone code automatically modifies the claim to 85%, which is what OHIP will pay for a phone visit. Similarly, when certain surgical procedures are combined, the largest is paid at 100% and every subsequent one pays a lower amount. This could be automatically applied using billing rules, reducing the number of claims that need to be "adjust to paid" after submission

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Apr 1 2025
Needs Review

Accuro EMR / Ontario

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have one procedure code modify another to be paid at a lower percentage

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