South African Medical Association

Modifiers applicable to endoscopic procedures
Modifiers 0074 to 0075

AM

0074

Endoscopic procedures performed with own equipment:

The value of modifier 0074 = 33,33% (1/3) of the procedure fee (plus "+" codes excluded), where endoscopic procedures are performed with own equipment

Extra information on Modifier 0074

  • Modifier 0074 may be used when endoscopic procedures are performed with own equipment
  • Modifier 0074 may be used for every endoscopic procedure done at the same setting, e.g. gastroscopy and colonoscopy = modifier 0074 x 2
  • This fee is chargeable by the doctor who owns or rents the equipment
  • Modifier 0074 may not be used in conjunction with modifier 0004 as endoscopic examination can safely be done in the doctor's consulting rooms.
  • Modifier 0074 may not be used in conjunction with modifier 0007 when the doctor uses his/her own endoscopy equipment in theatre.

AM

0075

Endoscopic procedures performed in own procedure room:

(a) The value of modifier 0075 = 21, 00 clinical procedure units, where endoscopic procedures are performed in own rooms.

(b) This fee is chargeable by medical doctors who own or rent the facility.

(c) Modifier 0075 may not be used in conjunction with modifier 0004.

(d) Please note: Modifier 0075 is not applicable to any of the items for diagnostic procedures in the otorhinolaryngology sections of the structure

Extra information on Modifier 0075

  • This fee is chargeable by doctor who owns or rents the facility
  • Modifier 0075 may only be charged once, regardless of the number of endoscopic procedures done at the same sitting, eg. gastroscopy and colonoscopy = modifier 0075 x 1
  • Modifier 0075 may not be used in conjunction with modifier 0004 for making the infrastructure available
  • Not appropriate with any of the diagnostic procedures in the otorhinolaryngology section e.g. naso-endoscopy (item 1019)

Difference between Modifier 0074 and 0075

Modifier 0074 - To enables the doctors to charge for the use of their own equipment.

Modifier 0075 - To enables the doctors to charge for the use of their own procedure rooms.

Example: The calculation for performing GI Endoscopy with own equipment and in own procedure room:

Item 1587 - Upper GI endoscopy = eg. R 100.00

Modifier 0074 (own equipment) = 1/3 of the value of item 1587 = R 33.33

Modifier 0075 (own procedure rooms) = 21.00 clinical procedure units (eg. R10.00/clinical procedure units) = R 210.00

Total value for the procedure performed in your own rooms with you own endoscopic equipment will be R 100.00 + R 33.33 + R 210.00 = R 343.33

(NB: Amounts on the example above are fictitious)

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