When to Use

Use Modifier 27 when:

• A patient has more than one outpatient hospital E/M encounter on the same date
• The encounters are medically necessary and distinct
• Each encounter is separately documented
• The visits occur in different outpatient departments or represent separate clinical presentations

Example scenarios:

• Patient seen in outpatient clinic in the morning and later returns through the emergency department
• Patient evaluated in the ED, discharged, and later returns with a new complaint

When Not to Use

Do NOT use Modifier 27 when:

• The encounters are part of the same continuous visit
• The patient is moved between departments without discharge
• It is being appended to a physician claim
• There is no separate medical necessity for the second visit

If the patient never truly leaves hospital care, Modifier 27 is usually inappropriate.

Common Denial Reasons

• Documentation does not support two distinct encounters
• Patient was never discharged between visits
• Second visit is related and continuous with first visit
• Modifier appended to physician claim instead of facility claim

Real-World Example

A patient presents to a hospital outpatient clinic for a scheduled follow-up in the morning.

Later that same day, the patient develops chest pain and presents to the emergency department.

If both visits are separately documented and medically necessary, the hospital may append Modifier 27 to the second E/M service.

CMS Guidance

CMS allows Modifier 27 to identify multiple outpatient hospital E/M encounters on the same date.

Key CMS principles:

• Applies to hospital outpatient claims only
• Not reported by physicians
• Encounters must be distinct and medically necessary
• Documentation must support separate visits

Modifier 27 is recognized under the Outpatient Prospective Payment System (OPPS).