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List Of All Modifiers

list of modifiers

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:

  1. Level I CPT Modifiers: Normally known as CPT Modifiers and consists of two numeric digits and are updated annually by AMA – American Medical Association.
  2. 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 21: Prolonged Evaluation and Management Services(Deleted, please use CPT 99354- CPT 99359)

CPT Modifier 22: Unusual Procedural Services

CPT Modifier 23: Unusual Anesthesia

CPT Modifier 24: Unrelated Evaluation and Management Service by the Same Physician during a Postoperative Period

CPT Modifier 25: Significant, Separately Identifiable Evaluation and Management Service by the Same Physician on the Same Day of the Procedure or Other Service

CPT Modifier 26: Professional Component

CPT Modifier 27: Multiple Outpatient Hospital E/M Encounters on the Same Date.

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 32: Mandated Services

CPT Modifier 33: Preventive Service

CPT Modifier 47: Anesthesia by Surgeon

CPT Modifier 50: Bilateral Procedure

CPT Modifier 51: Multiple Procedures

CPT Modifier 52: Reduced Services

CPT Modifier 53: Discontinued Procedure

CPT Modifier 54: Surgical Care Only

CPT Modifier 55: Postoperative Management Only

CPT Modifier 56: Preoperative Management Only

CPT Modifier 57: Decision for Surgery

CPT Modifier 58: Staged or Related Procedure or Service by the Same Physician During the Postoperative Period

CPT Modifier 59: Distinct Procedural Service

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

CPT Modifier 92: Alternative Laboratory Platform Testing

CPT Modifier 96: Habilitative Services

CPT Modifier 97: Rehabilitative Services

CPT Modifier 99: Multiple Modifiers

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 AV: Item furnished in conjunction with a prosthetic device, prosthetic or orthotic

Modifier AW: Item furnished in conjunction with a surgical dressing

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.

Reference: http://www.cms.gov/MLNMattersArticles/downloads/MM6683.pdf

Modifiers Used to Report the Severity of Functional Limitations (Effective for the year 2013)

Modifier CH: 0 percent impaired, limited or restricted

Modifier CI: At least 1 percent but less than 20 percent impaired, limited or restricted

Modifier CJ: At least 20 percent but less than 40 percent impaired, limited or restricted

Modifier CK: At least 40 percent but less than 60 percent impaired, limited or restricted

Modifier CL: At least 60 percent but less than 80 percent impaired, limited or restricted

Modifier CM: At least 80 percent but less than 100 percent impaired, limited or restricted

Modifier CN: 100 percent impaired, limited or restricted

Reference: http://www.cms.gov/Outreach-and-Education/Outreach/NPC/Downloads/FunctionalReportingNPC.pdf

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 EA: Erythropetic stimulating agent (ESA) administered to treat anemia due to anti-cancer chemotherapy.

Modifier EB: Erythropetic stimulating agent (ESA) administered to treat anemia due to anti-cancer radiotherapy.

Modifier EC: Erythropetic stimulating agent (ESA) administered to treat anemia not due to anti-cancer radiotherapy or anti-cancer chemotherapy.

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 FY: Designates imaging services that are X-rays taken using computed radiography.

Modifier G1: Most recent URR of less than 60%

Modifier G2: Most recent URR of 60% to 64.9%

Modifier G3: Most recent URR of 65% to 69.9%

Modifier G4: Most recent URR of 70% to 74.9%

Modifier G5: Most recent URR of 75% or greater

Modifier G6: ESRD patient for whom less than seven dialysis sessions have been provided in a month.

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 GJ: Opted Out physician or practitioner – Use to indicate services performed in an emergency or urgent service.

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 KF: Item designated by FDA as Class III device

Modifier KL: DMEPOS Item Delivered via Mail

Modifier KM: Replacement of facial prosthesis – including new impression/moulage

Modifier KN: Replacement of facial prosthesis – Using previous master model

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 QQ: Ordering Professional Consulted A Qualified Clinical Decision Support Mechanism For This Service And The Related Data Was Provided To The Furnishing Professional.

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.