What does modifier 35 indicate in CPT coding?

Modifier 35 in CPT coding indicates mandated consultation. This modifier is used to signify that a consultation was requested by another physician or to communicate that the service was provided at the behest of another entity, often due to a legal requirement or insurance policy stipulation. It highlights the context in which the consultation occurred, emphasizing that the physician's evaluation and management were triggered by external factors beyond the patient's or physician's control.

The use of this modifier can help to inform payers and other stakeholders that the consultation was not initiated solely by the patient or the consulting physician's clinical judgment, but rather as a necessary response to specific mandates or regulations. Understanding this modifier is crucial for accurate billing and proper reimbursement, ensuring that consultations are appropriately documented and recognized in the healthcare system.