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Network Matters
News and Information for the
Harvard Pilgrim Health Care Network

April 2017

Payment Policy Update: Anatomical Modifiers

In June, Harvard Pilgrim will require that the appropriate anatomical modifier be appended to claims for applicable procedures. Anatomical modifiers are used to indicate the specific area or part of the body on which a procedure was performed. Effective for dates of service beginning June 15, 2017, Harvard Pilgrim is requiring the use of the following modifiers whenever they apply to a procedure you have performed:

  • E1-E4 – Eyelids
  • FA, F1-F9 – Fingers
  • TA, T1-T9 – Toes
  • LC – Left circumflex, coronary artery
  • LD – Left anterior descending coronary artery
  • LM – Left main coronary artery
  • RI – Ramus intermedius
  • RC – Right coronary artery

Failure to append the anatomical modifier, or appending an anatomical modifier that does not match the appropriate anatomical site, may result in a claim denial. For more information, refer to Harvard Pilgrim’s updated CPT and HCPCS Level II Modifiers Payment Policy.

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Eric H. Schultz,
President and Chief Executive Officer

Robert Farias,
Vice President, Network Services

Annmarie Dadoly,

Joseph O'Riordan,

Kristin Edmonston,
Production Coordinator