Modifier – as the name implies a modifier will modify a service / procedure or an item under certain circumstances for appropriate reimbursement. Modifiers may add information or change the description according to the physician documentation to give more specificity for the service or procedure rendered. Appending of an appropriate modifier will effectively respond to reimbursement.
Modifiers are two digit codes and are categorized into two levels:
- Level I CPT Modifiers: Normally known as CPT Modifiers and consists of two numeric digits and are updated annually by AMA – American Medical Association.
- Level II HCPCS Modifiers: Normally known as HCPCS Modifiers and consists of two digits (Alpha / Alphanumeric characters) in the sequence AA through VP. These modifiers are annually updated by CMS – Centres for Medicare and Medicaid Services.
Both the above levels of Modifiers are recognized nationally.
List Of All Modifiers – Level I CPT Modifiers
CPT Modifier 29: Global procedures, those procedures where one provider is responsible for both the professional and technical component. This modifier has been deleted. If a provider is billing for a global service, no modifier is necessary.
CPT Modifier 62: Two Surgeons
CPT Modifier 63: Procedure Performed on Infants less than 4kg
CPT Modifier 66: Surgical Team
CPT Modifier 73: Discontinued Outpatient Hospital/Ambulatory Surgery Center (ASC) Procedure prior to the Administration of Anesthesia
CPT Modifier 74: Discontinued Outpatient Hospital/Ambulatory Surgery Center (ASC) Procedure after Administration of Anesthesia
CPT Modifier 76: Repeat Procedure by Same Physician
CPT Modifier 77: Repeat Procedure by Another Physician
CPT Modifier 78: Return to the Operating Room for a Related Procedure During the Postoperative Period
CPT Modifier 79: Unrelated Procedure or Service by the Same Physician During the Postoperative Period
CPT Modifier 80: Assistant Surgeon
CPT Modifier 81: Minimum Assistant Surgeon
CPT Modifier 82: Assistant Surgeon (when qualified resident surgeon not available)
CPT Modifier 90: Reference (Outside) Laboratory
CPT Modifier 91: Repeat Clinical Diagnostic Laboratory Test
List Of All Modifiers – HCPCS Level II Modifiers
Modifier AA: Anesthesia services personally performed by anesthesiologist.
Modifier AD: Medical supervision by a physician: More than 4 concurrent anesthesia procedures.
Modifier AE: Registered Dietician
Modifier AF: Specialty Physician
Modifier AG: Primary Physician
Modifier AH: Clinical Psychologist
Modifier AI: Principal Physician of Record
Modifier AJ: Clinical Social Worker
Modifier AK: Non Participating Physician
Modifier AM: Physician, team member service
Modifier AP: Determination of refractive state was not performed in the course of diagnostic ophthalmological examination.
Modifier AQ: Service performed in a Health Professional Shortage Area
Modifier AR: Physician providing services in a physician scarcity area
Modifier AS: Physician Assistant, Nurse Practitioner, or Clinical Nurse Specialist services for assistant-at-surgery, non-team member.
Modifier AT: Acute treatment (chiropractic claims) – This modifier should be used when reporting CPT 98940, CPT 98941, CPT 98942 or CPT 98943 for acute treatment.
Modifier AU: Item furnished in conjunction with a urological, ostomy, or tracheostomy supply
Modifier AX: Item furnished in conjunction with dialysis services
Modifier AY: Item or service furnished to an ESRD patient that is not for the treatment of ERSD
Modifier AZ: Physician providing a service in a dental Health Professional Shortage Area for the purpose of an Electronic Health Record Incentive Payment
Modifier A1: Dressing for one wound
Modifier A2: Dressing for two wounds
Modifier A3: Dressing for three wounds
Modifier A4: Dressing for four wounds
Modifier A5: Dressing for five wounds
Modifier A6: Dressing for six wounds
Modifier A7: Dressing for seven wounds
Modifier A8: Dressing for eight wounds
Modifier A9: Dressing for nine or more wounds
Modifier BA: Item furnished in conjunction with parenteral enteral nutrition (PEN) services
Modifier BL: Special Acquisition of blood and blood products
Modifier CA: Procedure payable only in the inpatient setting when performed emergently on an outpatient who expires prior to admission.
Modifier CB: Services ordered by a dialysis facility physician as part of the ESRD beneficiary’s dialysis benefit.
Modifier CC: Procedure code change- CARRIER USE ONLY – Used by carrier to indicate that the procedure code submitted was changed either for administrative reasons or because an incorrect code was filed.
Automated Multi-Channel Chemistry (AMCC) Tests Modifiers – Effective date: Claims processed on or after April 5, 2010
Modifier CD: AMCC test has been ordered by an ESRD facility or MCP physician that is part of the composite rate and is not separately billable.
Modifier CE: AMCC tests has been ordered by an ESRD facility or MCP physician that is a composite rate test but is beyond the normal frequency covered under the rate and is separately reimbursable based on medical necessity.
Modifier CF: AMCC tests has been ordered by an ESRD facility or MCP physician that is not part of the composite rate and is separately billable.
Modifiers Used to Report the Severity of Functional Limitations (Effective for the year 2013)
Modifier CR: Catastrophe/Disaster Related
Modifier CS: Item or service related, in whole or in part, to an illness, injury, or condition that was caused by or exacerbated by the effects, direct or indirect, of the 2010 oil spill in the Gulf of Mexico, including but not limited to subsequent clean-up activities.
Modifier DA: Oral health assessment by a licensed Health Professional other than a dentist
Modifier ED: Hematocrit level has exceeded 39% (or Hemoglobin level has exceeded 13.0 G/DL) for 3 or more consecutive billing cycles immediately prior to and including the current cycle
Modifier EE: Hematocrit level has not exceeded 39% (or Hemoglobin level has not exceeded 13.0 G/DL) for 3 or more consecutive billing cycles immediately prior to and including the current cycle.
Modifier E1: Upper left, eyelid
Modifier E2 – Lower left, eyelid
Modifier E3: Upper right, eyelid
Modifier E4: Lower right, eyelid
Modifier EJ: Subsequent claims for a defined course of therapy, e.g., EPO, sodium hyaluronate, infliximab.
Modifier EM: Emergency reserve supply (for ESRD benefit only)
Modifier ET: Emergency treatment – Use to designate a dental procedure performed in an emergency situation.
Modifier FA: Left hand, thumb
Modifier F1: Left hand, second digit
Modifier F2: Left hand, third digit
Modifier F3: Left hand, fourth digit
Modifier F4: Left hand, fifth digit
Modifier F5: Right hand, thumb
Modifier F6: Right hand, second digit
Modifier F7: Right hand, third digit
Modifier F8: Right hand, fourth digit
Modifier F9: Right hand, fifth digit
Modifier FB: Item provided without cost to provider, supplier or practitioner, or credit received for replaced device (examples, but not limited to covered under warranty, replaced due to defect, free samples)
Modifier FC: Partial credit received for replaced device
Modifier G7: Pregnancy resulted from rape or incest or pregnancy certified by physician as life threatening
Modifier GA: Waiver of liability statement on file – Use to indicate that the physician’s office has a signed advance notice retained in the patient’s medical record.The notice is for services that may be denied by Medicare.
Modifier GC: This service has been performed in part by a resident under the direction of a teaching physician.
Modifier GD: Units of service exceeds medically unlikely edit value and represents reasonable and necessary services.
Modifier GE: This service has been performed by a resident without the presence of a teaching physician under the primary care exception.
Modifier GF: Physician services provided by a nonphysician in a critical access hospital; nonphysician: NP, Certified Registered Nurse Anesthetist (CRNA), Certified Registered Nurse (CRN), CNS or PA
Modifier GG: Diagnostic Mammography – Use to indicated performance and payment of a screening mammography and diagnostic mammography on same patient, on the same day.
Modifier GH: Diagnostic mammogram converted from screening mammogram on same day
Modifier GM: Multiple patients on one ambulance trip
Modifier GN: Services delivered under an outpatient speech language pathology plan of care.
Modifier GO: Services delivered under an outpatient occupational therapy plan of care.
Modifier GP: Services delivered under an outpatient physical therapy plan of care.
Modifier GQ: Telehealth services via asynchronous telecommunications system
Modifier GR: This service was performed in whole or in part by a resident in a department of Veterans Affairs Medical Center or clinic supervised in accordance with VA policy.
Modifier GS: Dosage of EPO or Darbepoietin Alfa has been reduced and maintained in response to hematocrit or hemoglobin level.
Modifier GT: Telehealth services via interactive audio and video telecommunication systems
Modifier GU: Waiver of liability statement issued as required by a payer policy, routine notice
Modifier GW: Service not related to the hospice patient’s terminal condition.
Modifier GV: Attending physician not employed or paid under agreement by the patient’s hospice provider.
Modifier GY: Use to indicate when an item or service statutorily excluded or does not meet the definition of any Medicare benefit.
Modifier GZ: Use to indicate when an item or service expected to be denied as not reasonable and necessary.Used when no Advanced Beneficiary Notice (ABN) signed by the beneficiary.
Modifier HM: Less than Bachelor’s degree level
Modifier HN: Bachelor’s degree level
Modifier HO: Master’s degree level
Modifier HP: Doctoral level
Modifier HQ: Group setting (for behavioral health use)
Modifier HT: Multidisciplinary team (for behavioral health use)
Services Funded by a county, state or federal agency
Modifier H9: Court-ordered
Modifier HU: Funded by child welfare agency
Modifier HV: Funded state addictions agency
Modifier HW: Funded by state mental health agency
Modifier HX: Funded by county/local agency
Modifier HY: Funded by juvenile justice agency
Modifier HZ: Funded by criminal justice agency
Modifier J1: Competitive Acquisition Program, no-pay submission for a prescription number
Modifier J2: Competitive Acquisition Program, restocking of emergency drugs after emergency administration
Modifier J3: Competitive Acquisition Program, (CAP) drug not available through CAP as written, reimburse under ASP Methodology
Modifier JA: Administered intravenously
Modifier JB: Administered subcutaneoulsly
Modifier JC: Skin substitute used as a graft
Modifier JD: Skin substitute NOT used as a graft
Modifier JW: Drug or biological amount discarded/not administered to any patient
Modifier KB: Beneficiary requested upgrade for ABN, more than 4 modifiers identified on claim
Modifier KC: Replacement of special power wheelchair interface
Modifier KD: Drug or Biological infused through implanted DME
Modifier KE: Bid under round one of the DMEPOS competitive bidding program for use with non-competitive bid base equipment
Modifier KR: Rental item, durable medical equipment – billing for partial month
Modifier KX: Specific required documentation on file (used for DMERC providers)
Modifier KZ: New Coverage not implemented by managed care
Modifier LC: Left circumflex coronary artery
Modifier LD: Left anterior descending coronary artery
Modifier LM: Left main coronary artery (Effective for the year 2013)
Modifier LR: Laboratory Round Trip.
Modifier LT: Left Side – Used to identify procedures performed on the left side of the body.
Modifier M2: Medicare Secondary Payer
Modifier NB: Nebulizer system, any type, FDA-Cleared fo ruse with specific drug
Modifier NU: New equipment (DME)
Modifier P1: A normal healthy patient
Modifier P2: A patient with mild systemic disease
Modifier P3: A patient with severe systemic disease
Modifier P4: A patient with severe systemic disease that is a constant threat to life
Modifier P5: A moribund patient who is not expected to survive without the operation
Modifier P6: A declared brain-dead patient whose organs are being removed for donor purposes
Modifier PA: Surgery Wrong Body Part
Modifier PB: Surgery Wrong Patient
Modifier PC: Wrong Surgery on Patient
Please refer: http://www.cms.hhs.gov/MLNMattersArticles/downloads/MM6718.pdf for proper usage of PA, PB and PC Modifiers
Modifier PD: Diagnostic or related non-diagnostic item or service provided in a wholly owned or wholly operated entity to a patient who is admitted as an inpatient within 3 days, or 1 day. (New modifier for the year 2012, Check for Usage and reimbursement)
Modifier PI: PET Tumor init tx strategy
Modifier PS: PET Tumor subsq tx strategy
Modifier PT: Colorectal cancer screening test; converted to diagnostic test or other procedure
Modifier PO: Services, procedures and/or surgeries provided at off-campus provider-based outpatient departments
Modifier Q0: Investigational clinical service provided in a clinical research study that is in an approved clinical research study.
Modifier Q1: Routine clinical service provided in a clinical research study that is in an approved clinical research study.
Modifier Q3: Liver Kidney Donor Surgery and Related Services.
Modifier Q4: Service for ordering/referring physician qualifies as a service exemption –
Modifier Q5: Service furnished by a substitute physician under a reciprocal billing arrangement
Modifier Q6: Service furnished by a locum tenens physician
Modifier Q7: One CLASS A finding
Modifier Q8: Two CLASS B findings
Modifier Q9: One CLASS B and two CLASS C findings
Modifier QA: FDA Investigational device exemption (IDE) – The IDE project number must be included on the claim when modifier QA is billed.
Modifier QB: Physician service in a rural HPSA.
Modifier QC: Single channel monitoring.
Modifier QD: Recording and storage in solid state memory by a digital recorder.QJ Services/items provided to a prisoner or patient in state or local custody, however the state or local government, as applicable, meets the requirements in 42 CFR 411.4 (B)
Modifier QK: Medical direction of 2, 3 or 4 concurrent anesthesia procedures involving qualified individuals.
Modifier QL: Patient pronounced dead after ambulance called
Modifier QM: Ambulance service provided under arrangement by a provider of services
Modifier QN: Ambulance service furnished directly by a provider of services
QP Panel test – Documentation is on file showing that the laboratory test(s) was ordered individually or ordered as a CPT-recognized panel other than automated profile codes.
Modifier QS: Monitored anesthesia care
Modifier QT: Recording and storage on tape by an analog tape recorder.
Modifier QU: Physician service in an urban HPSA.
Modifier QV: Item or service provided as routine care in a medical qualifying clinical trial
Modifier QW: CLIA Waived Test – Effective October 1, 1996, all new waived tests are being assigned a CPT code (in lieu of a temporary five-digit G- or Q-code).
Modifier QX: CRNA service with medical direction by physician.
Modifier QY: Medical direction of one certified registered nurse anesthetist (CRNA) by an anesthesiologist.
Modifier QZ: CRNA service without medical direction by a physician.
Modifier RA: Replacement of a DME item, Orthotic or Prosthetic Item
Modifier RB: Replacement of a Part of DME, Orthotic or Prosthetic Item furnished as Part of a Repair
Modifier RC: Right coronary artery
Modifier RD: Drug provided to beneficiary, but not, administrated incident-to
Modifier RE: Furnished in full compliance with FDA-Mandated Risk Evaluation and Mitigation Strategy (REMS)
Modifier RI: Ramus intermedius (Effective for the year 2013)
Modifier RP: Replacement and repair
Modifier RT: Right Side – Used to identify procedures performed on the right side of the body.
Modifier RR: Rental (use the RR modifier when DME is a rental)
Modifiers SB NP: (for use by midwives only)
Modifier SC: Medically necessary service or supply (w.e.f Jan 1, 2012)
Modifier SF: Second opinion ordered by a Professional Review Organization (PRO) per section 9401, P.L. 99-272 (100 % reimbursement – no Medicare deductible or coinsurance)
SG Ambulatory Surgical Center (ASC) modifier
Modifier SH: Second concurrently administered infusion therapy
SJ Third or more concurrently administered infusion therapy
Modifier SK: Member of high risk population (Use only with codes for immunization)
Modifier SS: Home infusion services provided in the infusion suite of the IV therapy provider
Modifier SW: Services provided by a certified diabetes educator
Modifier TA: Left foot, great toe
Modifier T1: Left foot, second digit
Modifier T3: Left foot, fourth digit
Modifier T2: Left foot, third digit
Modifier T4: Left foot, fifth digit
Modifier T5: Right foot, great toe
Modifier T6: Right foot, second digit
Modifier T7: Right foot, third digit
Modifier T8: Right foot, fourth digit
Modifier T9: Right foot, fifth digit
Modifier TC: Technical component only – Use to indicate the technical part of a diagnostic procedure performed.
Modifier TD: Registered Nurse (RN) (for behavioral health use)
Modifier TE: Licensed Practical Nurse (LPN) (for behavioral health use)
Modifier TJ: Child/Adolescent Program GP: To be used for enhancement payment for foster care children screening exams.
Modifier TK: Extra member or passenger, nonambulance transportation
Modifier TR: School-based individualized education program services provided outside the public school district responsible for the student
Modifier TS: Follow-up service
Modifier UE: Used durable medical equipment
Modifier UN: Portable X-ray Modifiers; two patients
Modifier UP: Portable X-ray Modifiers; three patients
Modifier UQ: Portable X-ray Modifiers; four patients
Modifier UR: Portable X-ray Modifiers; five patients
Modifier US: Portable X-ray Modifiers; six patients
Modifier V1: Level of MMI for Treating Doctor – This modifier would be added to the “Work related or medical disability examination by the treating physician…” CPT code 99455 when the office visit level of service is equal to a “minimal” level.
Modifier V2: Level of MMI for Treating Doctor – This modifier would be added to the “Work related or medical disability examination by the treating physician…” CPT code 99455 when the office visit level of service is equal to “self limited or minor” level.
Modifier V3: Level of MMI for Treating Doctor – This modifier would be added to the “Work related or medical disability examination by the treating physician…” CPT code 99455 when the office visit level of service is equal to “low to moderate” level.
Modifier V4: Level of MMI for Treating Doctor – This modifier would be added to the “Work related or medical disability examination by the treating physician…” CPT code 99455 when the office visit level of service is equal to “moderate to high severity” level and of at least 25 minutes duration.
Modifier V5: Level of MMI for Treating Doctor – This modifier would be added to the “Work related or medical disability examination by the treating physician…” CPT code 99455 when the office visit level of service is equal to “moderate to high severity” level and of at least 45 minutes duration.
Modifier V5: Any Vascular Catheter (alone or with any other vascular access) – Part A only modifier
Modifier V6: Arteriovenous Graft (or other vascular access not including a vascular catheter) – Part A only modifier
Modifier V7: Afteriovenous Fistula (or other vascular access not including a vascular catheter) – Part A only modifier
Modifier V8: Dialysis related infection present during the billing month – Part A only modifier
Modifier V9: No dialysis related infection present during the billing month – Part A only modifier
Modifier VR: Review report – This modifier shall be added to the “Work related or medical disability examination by the treating physician…” CPT code 99455 to indicate that the service was the treating doctor’s review of report(s) only.
Modifier XE: Separate Encounter, A Service That Is Distinct Because It Occurred During A Separate Encounter,
Modifier XS: Separate Structure, A Service That Is Distinct Because It Was Performed On A Separate Organ/Structure,
Modifier XP: Separate Practitioner, A Service That Is Distinct Because It Was Performed By A Different Practitioner, and
Modifier XU: Unusual Non-Overlapping Service, The Use Of A Service That Is Distinct Because It Does Not Overlap Usual Components Of The Main Service.
Modifier ZA: (Anesthesia modifier especially used for Medi-cal insurance of California) denotes prone position or surgical field avoidance. To be used only for procedures that have a base value of three (3) units. These techniques are included in the anesthesia base value of surgical procedures with a base value of more than three.
Modifier ZE: (Anesthesia modifier especially used for Medical insurance of California) To be billed with the appropriate five-digit CPT-4 anesthesia code to identify a normal, uncomplicated anesthesia provided by a Certified Registered Nurse Anesthetist (CRNA).
Note: Please check the respective insurance guidelines for appropriate usage of Modifiers to avoid denials.