In simple words: Modifier CG means the doctor followed specific rules set by the insurance company for the service provided.

Modifier CG is used to indicate that the provider has applied relevant policy criteria to the reported service. Payers may require this modifier to ensure that services meet coverage criteria, bypass specific edits, or identify services subject to coinsurance and deductible.While applicable to various procedures, it's notably used in Rural Health Clinics (RHCs) for Medicare claims and adjustments, linked to the primary reason for the visit.

Example 1: A patient visits an RHC for a medically necessary face-to-face visit for evaluation and management of hypertension. The provider appends modifier CG to the appropriate E/M code to indicate compliance with Medicare's RHC billing requirements., A patient receives a preventive service at an RHC. The provider uses modifier CG with the preventive service code to signify it as the primary reason for the visit and to comply with payer guidelines for coinsurance and deductible application., A payer requires modifier CG for a specific service to bypass an edit that would normally bundle it with another service. The provider appends the modifier to ensure correct processing and payment.

Documentation must support the medical necessity of the service and demonstrate how the policy criteria were met. For RHCs, documentation should clearly identify the primary reason for the visit.

** Modifier CG is informational and does not guarantee payment. It signifies that the provider believes the service meets the payer's specified criteria. Proper documentation is crucial for supporting the use of the modifier and ensuring appropriate reimbursement.