Modifier –22 (Increased Procedural Services) is used when a reported procedure is substantially more extensive than normally required. The CPT Manual and CMS state it may be appended only when the service performed is substantially greater than the usual service described by the CPT code — driven by increased intensity, technical difficulty, or unusual complexity rather than routine variation. It is appropriate only on procedural codes (not E/M codes) and is typically applied to the primary procedure code rather than add‑on codes.

Because modifier –22 denotes an atypically extensive service, documentation must clearly justify the increased work: a detailed operative report, specific descriptions of factors such as dense adhesions, excessive bleeding, trauma, or unusual anatomy, and—when required by the payer—additional written explanation or a carrier‑specific form. Payers commonly require submission of supporting documentation and may decline use when the complexity reflects a provider’s routine case mix.

Including modifier –22 does not guarantee extra payment; it triggers medical review and case‑by‑case adjudication. Some carriers may provide additional reimbursement (often cited in coding guidance as roughly 20–30% when justified), but payment is not automatic. For Medicare, modifier –22 does not bypass NCCI edits; providers may request readjudication from their MAC when clinical circumstances justify increased payment. When multiple procedures are billed, payers typically apply multiple‑procedure reductions before considering any additional payment related to modifier –22.