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CPT 90833 is exclusively an add-on code. It cannot be billed alone. It allows a provider to capture the time and effort of psychotherapy delivered alongside a medical visit (e.g., 99213, 99214, 99204) .
Eligible Providers: Only clinicians credentialed to perform E/M services may bill this code. This includes Psychiatrists (MD/DO), Nurse Practitioners (NP), and Physician Assistants (PA).
Ineligible Providers: Clinical Psychologists (PhD/PsyD) and Social Workers (LCSW) cannot bill 90833 because they cannot bill the prerequisite E/M code. They must use standalone therapy codes (90832, 90834) .
To validly bill 90833, the provider must perform two distinct services in the same session:
CPT guidelines use a “midpoint rule.” While 90833 is described as 30 minutes, it can be billed for any session lasting between 16 and 37 minutes .
Critical Note: If the therapy portion is 15 minutes or less, do not bill 90833. You may only bill the E/M code. The therapy in this case is considered incidental .
To survive a recoupment audit, your documentation should be visually separated into two distinct sections. Auditors look for “distinct and separately identifiable” services .
Section 1: Medical/E/M Note
Assessment: “Depression stable on Sertraline 100mg. No new side effects. Sleep improved.”
Plan: “Continue current dose. Refill sent.”
Code Selection: 99214 (based on Medical Decision Making).
Section 2: Psychotherapy Note
Time: “25 minutes spent on psychotherapy.” (Must be explicit)
Intervention: “Utilized Cognitive Behavioral Therapy (CBT) to identify cognitive distortions regarding workplace performance. Patient practiced reframing negative thoughts.”
Code Selection: +90833.
Common Audit Failure: CMS audits frequently cite “Time not documented” as a reason for denial. You must write the exact number of minutes spent on therapy .
Commercial Payer Alert: Unlike Medicare, private payers (Blue Cross, Cigna, UHC) often strictly enforce the use of Modifier 25 on the E/M code. Omitting it frequently results in automatic denial of the E/M service as “bundled” .
| Code | Time Range | E/M Included? | Who Bills? |
|---|---|---|---|
| 90832 | 16-37 min | NO | Therapists, MDs (Therapy only) |
| 90833 | 16-37 min | YES (Add-on) | MD/DO/NP/PA Only |
| 90834 | 38-52 min | NO | Therapists, MDs (Therapy only) |
| 90836 | 38-52 min | YES (Add-on) | MD/DO/NP/PA Only |
© Copyright 2026 American Medical Association. All rights reserved.
CPT® Code 90833 refers to a specific type of psychotherapy that is conducted for a duration of 30 minutes with the patient. This service is distinct in that it is performed concurrently with an evaluation and management (E/M) service. The primary focus of this psychotherapy session is to provide individual support through various therapeutic techniques, including re-education, reassurance, and insight discussions. These methods aim to facilitate behavior modification by enhancing the patient's self-understanding and addressing family relationship dynamics that may impact the patient's mental health condition. It is important to note that if psychotherapy is delivered independently, different codes are utilized based on the duration of the session: 90832 for 30 minutes, 90834 for 45 minutes, and 90837 for 60 minutes. However, when psychotherapy is provided alongside E/M services, the appropriate code to report is 90833 for a 30-minute session. This coding structure allows for accurate billing and documentation of the services rendered, ensuring that both the psychotherapy and the evaluation and management components are appropriately recognized in the patient's treatment plan.
© Copyright 2026 Coding Ahead. All rights reserved.
The indications for utilizing CPT® Code 90833 include various mental health conditions and situations where psychotherapy is deemed beneficial in conjunction with evaluation and management services. These may encompass:
The procedure associated with CPT® Code 90833 involves several key steps that ensure effective delivery of psychotherapy in conjunction with evaluation and management services. These steps include:
After the completion of the psychotherapy session coded as 90833, the patient may be advised on follow-up care and any additional therapeutic strategies that may be beneficial. The therapist may recommend ongoing psychotherapy sessions, further evaluation, or adjustments to any prescribed medications. It is also important for the patient to have access to resources or support systems that can aid in their mental health journey. The expected recovery or improvement timeline will vary based on the individual patient's circumstances and the nature of their mental health issues. Regular follow-up appointments may be scheduled to monitor progress and make necessary adjustments to the treatment plan.
| Short Descr | PSYTX W PT W E/M 30 MIN | Medium Descr | PSYCHOTHERAPY W/PATIENT W/E&M SRVCS 30 MIN | Long Descr | Psychotherapy, 30 minutes with patient when performed with an evaluation and management service (List separately in addition to the code for primary procedure) | Status Code | Active Code | Global Days | ZZZ - Code Related to Another Service | PC/TC Indicator (26, TC) | 0 - Physician Service Code | Multiple Procedures (51) | 0 - No payment adjustment rules for multiple procedures apply. | Bilateral Surgery (50) | 0 - 150% payment adjustment for bilateral procedures does NOT apply. | Physician Supervisions | 09 - Concept does not apply. | Assistant Surgeon (80, 82) | 9 - Concept does not apply. | Co-Surgeons (62) | 0 - Co-surgeons not permitted for this procedure. | Team Surgery (66) | 0 - Team surgeons not permitted for this procedure. | Diagnostic Imaging Family | 99 - Concept Does Not Apply | APC Status Indicator | Items and Services Packaged into APC Rates | Type of Service (TOS) | 1 - Medical Care | Berenson-Eggers TOS (BETOS) | M5B - Specialist - psychiatry | MUE | 2 | CCS Clinical Classification | 218 - Psychological and psychiatric evaluation and therapy |
This is an add-on code that must be used in conjunction with one of these primary codes.
| 99202 | Telehealth Service (Medicare) MPFS Status: Active Code APC B Physician Quality Reporting PUB 100 CPT Assistant Article Office or other outpatient visit for the evaluation and management of a new patient, which requires a medically appropriate history and/or examination and straightforward medical decision making. When using total time on the date of the encounter for code selection, 15 minutes must be met or exceeded. | 99203 | Telehealth Service (Medicare) MPFS Status: Active Code APC B Physician Quality Reporting PUB 100 CPT Assistant Article Office or other outpatient visit for the evaluation and management of a new patient, which requires a medically appropriate history and/or examination and low level of medical decision making. When using total time on the date of the encounter for code selection, 30 minutes must be met or exceeded. | 99204 | Telehealth Service (Medicare) MPFS Status: Active Code APC B Physician Quality Reporting PUB 100 CPT Assistant Article Office or other outpatient visit for the evaluation and management of a new patient, which requires a medically appropriate history and/or examination and moderate level of medical decision making. When using total time on the date of the encounter for code selection, 45 minutes must be met or exceeded. | 99205 | Telehealth Service (Medicare) MPFS Status: Active Code APC B Physician Quality Reporting PUB 100 CPT Assistant Article Office or other outpatient visit for the evaluation and management of a new patient, which requires a medically appropriate history and/or examination and high level of medical decision making. When using total time on the date of the encounter for code selection, 60 minutes must be met or exceeded. | 99211 | Telehealth Service (Medicare) Telemedicine Service (AMA) MPFS Status: Active Code APC B Physician Quality Reporting PUB 100 CPT Assistant Article Office or other outpatient visit for the evaluation and management of an established patient that may not require the presence of a physician or other qualified health care professional | 99212 | Telehealth Service (Medicare) MPFS Status: Active Code APC B Physician Quality Reporting PUB 100 CPT Assistant Article Office or other outpatient visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination and straightforward medical decision making. When using total time on the date of the encounter for code selection, 10 minutes must be met or exceeded. | 99213 | Telehealth Service (Medicare) MPFS Status: Active Code APC B Physician Quality Reporting PUB 100 CPT Assistant Article Office or other outpatient visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination and low level of medical decision making. When using total time on the date of the encounter for code selection, 20 minutes must be met or exceeded. | 99214 | Telehealth Service (Medicare) MPFS Status: Active Code APC B Physician Quality Reporting PUB 100 CPT Assistant Article Office or other outpatient visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination and moderate level of medical decision making. When using total time on the date of the encounter for code selection, 30 minutes must be met or exceeded. | 99215 | Telehealth Service (Medicare) MPFS Status: Active Code APC B Physician Quality Reporting PUB 100 CPT Assistant Article Office or other outpatient visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination and high level of medical decision making. When using total time on the date of the encounter for code selection, 40 minutes must be met or exceeded. | 99221 | Telehealth Service (Medicare) MPFS Status: Active Code APC B Physician Quality Reporting PUB 100 CPT Assistant Article Initial hospital inpatient or observation care, per day, for the evaluation and management of a patient, which requires a medically appropriate history and/or examination and straightforward or low level medical decision making. When using total time on the date of the encounter for code selection, 40 minutes must be met or exceeded. | 99222 | Telehealth Service (Medicare) MPFS Status: Active Code APC B Physician Quality Reporting PUB 100 CPT Assistant Article Initial hospital inpatient or observation care, per day, for the evaluation and management of a patient, which requires a medically appropriate history and/or examination and moderate level of medical decision making. When using total time on the date of the encounter for code selection, 55 minutes must be met or exceeded. | 99223 | Telehealth Service (Medicare) MPFS Status: Active Code APC B Physician Quality Reporting PUB 100 CPT Assistant Article Initial hospital inpatient or observation care, per day, for the evaluation and management of a patient, which requires a medically appropriate history and/or examination and high level of medical decision making. When using total time on the date of the encounter for code selection, 75 minutes must be met or exceeded. | 99231 | Telehealth Service (Medicare) Telemedicine Service (AMA) MPFS Status: Active Code APC B Physician Quality Reporting PUB 100 CPT Assistant Article Subsequent hospital inpatient or observation care, per day, for the evaluation and management of a patient, which requires a medically appropriate history and/or examination and straightforward or low level of medical decision making. When using total time on the date of the encounter for code selection, 25 minutes must be met or exceeded. | 99232 | Telehealth Service (Medicare) Telemedicine Service (AMA) MPFS Status: Active Code APC B Physician Quality Reporting PUB 100 CPT Assistant Article Subsequent hospital inpatient or observation care, per day, for the evaluation and management of a patient, which requires a medically appropriate history and/or examination and moderate level of medical decision making. When using total time on the date of the encounter for code selection, 35 minutes must be met or exceeded. | 99233 | Telehealth Service (Medicare) Telemedicine Service (AMA) MPFS Status: Active Code APC B Physician Quality Reporting PUB 100 CPT Assistant Article Subsequent hospital inpatient or observation care, per day, for the evaluation and management of a patient, which requires a medically appropriate history and/or examination and high level of medical decision making. When using total time on the date of the encounter for code selection, 50 minutes must be met or exceeded. | 99234 | Telehealth Service (Medicare) MPFS Status: Active Code APC B Physician Quality Reporting PUB 100 CPT Assistant Article Hospital inpatient or observation care, for the evaluation and management of a patient including admission and discharge on the same date, which requires a medically appropriate history and/or examination and straightforward or low level of medical decision making. When using total time on the date of the encounter for code selection, 45 minutes must be met or exceeded. | 99235 | Telehealth Service (Medicare) MPFS Status: Active Code APC B Physician Quality Reporting PUB 100 CPT Assistant Article Hospital inpatient or observation care, for the evaluation and management of a patient including admission and discharge on the same date, which requires a medically appropriate history and/or examination and moderate level of medical decision making. When using total time on the date of the encounter for code selection, 70 minutes must be met or exceeded. | 99236 | Telehealth Service (Medicare) MPFS Status: Active Code APC B Physician Quality Reporting PUB 100 CPT Assistant Article Hospital inpatient or observation care, for the evaluation and management of a patient including admission and discharge on the same date, which requires a medically appropriate history and/or examination and high level of medical decision making. When using total time on the date of the encounter for code selection, 85 minutes must be met or exceeded. | 99238 | Telehealth Service (Medicare) MPFS Status: Active Code APC B Physician Quality Reporting PUB 100 CPT Assistant Article Hospital inpatient or observation discharge day management; 30 minutes or less on the date of the encounter | 99239 | Telehealth Service (Medicare) MPFS Status: Active Code APC B Physician Quality Reporting PUB 100 CPT Assistant Article Hospital inpatient or observation discharge day management; more than 30 minutes on the date of the encounter | 99242 | Telemedicine Service (AMA) MPFS Status: Not valid for Medicare purposes APC E1 Physician Quality Reporting PUB 100 CPT Assistant Article Office or other outpatient consultation for a new or established patient, which requires a medically appropriate history and/or examination and straightforward medical decision making. When using total time on the date of the encounter for code selection, 20 minutes must be met or exceeded. | 99243 | Telemedicine Service (AMA) MPFS Status: Not valid for Medicare purposes APC E1 Physician Quality Reporting PUB 100 CPT Assistant Article Office or other outpatient consultation for a new or established patient, which requires a medically appropriate history and/or examination and low level of medical decision making. When using total time on the date of the encounter for code selection, 30 minutes must be met or exceeded. | 99244 | Telemedicine Service (AMA) MPFS Status: Not valid for Medicare purposes APC E1 Physician Quality Reporting PUB 100 CPT Assistant Article Office or other outpatient consultation for a new or established patient, which requires a medically appropriate history and/or examination and moderate level of medical decision making. When using total time on the date of the encounter for code selection, 40 minutes must be met or exceeded. | 99245 | Telemedicine Service (AMA) MPFS Status: Not valid for Medicare purposes APC E1 Physician Quality Reporting PUB 100 CPT Assistant Article Office or other outpatient consultation for a new or established patient, which requires a medically appropriate history and/or examination and high level of medical decision making. When using total time on the date of the encounter for code selection, 55 minutes must be met or exceeded. | 99252 | Telemedicine Service (AMA) MPFS Status: Not valid for Medicare purposes APC E1 Physician Quality Reporting PUB 100 CPT Assistant Article Inpatient or observation consultation for a new or established patient, which requires a medically appropriate history and/or examination and straightforward medical decision making. When using total time on the date of the encounter for code selection, 35 minutes must be met or exceeded. | 99253 | Telemedicine Service (AMA) MPFS Status: Not valid for Medicare purposes APC E1 Physician Quality Reporting PUB 100 CPT Assistant Article Inpatient or observation consultation for a new or established patient, which requires a medically appropriate history and/or examination and low level of medical decision making. When using total time on the date of the encounter for code selection, 45 minutes must be met or exceeded. | 99254 | Telemedicine Service (AMA) MPFS Status: Not valid for Medicare purposes APC E1 Physician Quality Reporting PUB 100 CPT Assistant Article Inpatient or observation consultation for a new or established patient, which requires a medically appropriate history and/or examination and moderate level of medical decision making. When using total time on the date of the encounter for code selection, 60 minutes must be met or exceeded. | 99255 | Telemedicine Service (AMA) MPFS Status: Not valid for Medicare purposes APC E1 Physician Quality Reporting PUB 100 CPT Assistant Article Inpatient or observation consultation for a new or established patient, which requires a medically appropriate history and/or examination and high level of medical decision making. When using total time on the date of the encounter for code selection, 80 minutes must be met or exceeded. | 99304 | Telehealth Service (Medicare) MPFS Status: Active Code APC B Physician Quality Reporting PUB 100 CPT Assistant Article Initial nursing facility care, per day, for the evaluation and management of a patient, which requires a medically appropriate history and/or examination and straightforward or low level of medical decision making. When using total time on the date of the encounter for code selection, 25 minutes must be met or exceeded. | 99305 | Telehealth Service (Medicare) MPFS Status: Active Code APC B Physician Quality Reporting PUB 100 CPT Assistant Article Initial nursing facility care, per day, for the evaluation and management of a patient, which requires a medically appropriate history and/or examination and moderate level of medical decision making. When using total time on the date of the encounter for code selection, 35 minutes must be met or exceeded. | 99306 | Telehealth Service (Medicare) MPFS Status: Active Code APC B Physician Quality Reporting PUB 100 CPT Assistant Article Initial nursing facility care, per day, for the evaluation and management of a patient, which requires a medically appropriate history and/or examination and high level of medical decision making. When using total time on the date of the encounter for code selection, 50 minutes must be met or exceeded. | 99307 | Telehealth Service (Medicare) Telemedicine Service (AMA) MPFS Status: Active Code APC B Physician Quality Reporting PUB 100 CPT Assistant Article Subsequent nursing facility care, per day, for the evaluation and management of a patient, which requires a medically appropriate history and/or examination and straightforward medical decision making. When using total time on the date of the encounter for code selection, 10 minutes must be met or exceeded. | 99308 | Telehealth Service (Medicare) Telemedicine Service (AMA) MPFS Status: Active Code APC B Physician Quality Reporting PUB 100 Subsequent nursing facility care, per day, for the evaluation and management of a patient, which requires a medically appropriate history and/or examination and low level of medical decision making. When using total time on the date of the encounter for code selection, 20 minutes must be met or exceeded. | 99309 | Telehealth Service (Medicare) Telemedicine Service (AMA) MPFS Status: Active Code APC B Physician Quality Reporting PUB 100 Subsequent nursing facility care, per day, for the evaluation and management of a patient, which requires a medically appropriate history and/or examination and moderate level of medical decision making. When using total time on the date of the encounter for code selection, 30 minutes must be met or exceeded. | 99310 | Telehealth Service (Medicare) Telemedicine Service (AMA) MPFS Status: Active Code APC B Physician Quality Reporting PUB 100 CPT Assistant Article Subsequent nursing facility care, per day, for the evaluation and management of a patient, which requires a medically appropriate history and/or examination and high level of medical decision making. When using total time on the date of the encounter for code selection, 45 minutes must be met or exceeded. | 99315 | Telehealth Service (Medicare) MPFS Status: Active Code APC B Physician Quality Reporting PUB 100 CPT Assistant Article Nursing facility discharge management; 30 minutes or less total time on the date of the encounter | 99316 | Telehealth Service (Medicare) MPFS Status: Active Code APC B Physician Quality Reporting PUB 100 CPT Assistant Article Nursing facility discharge management; more than 30 minutes total time on the date of the encounter | 99341 | Telehealth Service (Medicare) MPFS Status: Active Code APC B Physician Quality Reporting PUB 100 CPT Assistant Article Home or residence visit for the evaluation and management of a new patient, which requires a medically appropriate history and/or examination and straightforward medical decision making. When using total time on the date of the encounter for code selection, 15 minutes must be met or exceeded. | 99342 | Telehealth Service (Medicare) MPFS Status: Active Code APC B Physician Quality Reporting PUB 100 CPT Assistant Article Home or residence visit for the evaluation and management of a new patient, which requires a medically appropriate history and/or examination and low level of medical decision making. When using total time on the date of the encounter for code selection, 30 minutes must be met or exceeded. | 99344 | Telehealth Service (Medicare) MPFS Status: Active Code APC B Physician Quality Reporting PUB 100 CPT Assistant Article Home or residence visit for the evaluation and management of a new patient, which requires a medically appropriate history and/or examination and moderate level of medical decision making. When using total time on the date of the encounter for code selection, 60 minutes must be met or exceeded. | 99345 | Telehealth Service (Medicare) MPFS Status: Active Code APC B Physician Quality Reporting PUB 100 CPT Assistant Article Home or residence visit for the evaluation and management of a new patient, which requires a medically appropriate history and/or examination and high level of medical decision making. When using total time on the date of the encounter for code selection, 75 minutes must be met or exceeded. | 99347 | Telehealth Service (Medicare) MPFS Status: Active Code APC B Physician Quality Reporting PUB 100 CPT Assistant Article Home or residence visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination and straightforward medical decision making. When using total time on the date of the encounter for code selection, 20 minutes must be met or exceeded. | 99348 | Telehealth Service (Medicare) MPFS Status: Active Code APC B Physician Quality Reporting PUB 100 CPT Assistant Article Home or residence visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination and low level of medical decision making. When using total time on the date of the encounter for code selection, 30 minutes must be met or exceeded. | 99349 | Telehealth Service (Medicare) MPFS Status: Active Code APC B Physician Quality Reporting PUB 100 CPT Assistant Article Home or residence visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination and moderate level of medical decision making. When using total time on the date of the encounter for code selection, 40 minutes must be met or exceeded. | 99350 | Telehealth Service (Medicare) MPFS Status: Active Code APC B Physician Quality Reporting PUB 100 CPT Assistant Article Home or residence visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination and high level of medical decision making. When using total time on the date of the encounter for code selection, 60 minutes must be met or exceeded. | G0463 | Medicare Coverage: Carrier Priced MPFS Status: Statutory exclusion (from MPFS, may be paid under other methodologies) APC J2 Hospital outpatient clinic visit for assessment and management of a patient | 0770T | Add-on Code MPFS Status: Carrier Priced APC E1 Virtual reality technology to assist therapy (List separately in addition to code for primary procedure) | 90785 | Telehealth Service (Medicare) Addon Code Telemedicine Service (AMA) Audio-Only Telemedicine (AMA) MPFS Status: Active Code APC N Interactive complexity (List separately in addition to the code for primary procedure) |
| 95 | Synchronous telemedicine service rendered via a real-time interactive audio and video telecommunications system: synchronous telemedicine service is defined as a real-time interaction between a physician or other qualified health care professional and a patient who is located at a distant site from the physician or other qualified health care professional. the totality of the communication of information exchanged between the physician or other qualified health care professional and the patient during the course of the synchronous telemedicine service must be of an amount and nature that would be sufficient to meet the key components and/or requirements of the same service when rendered via a face-to-face interaction. modifier 95 may only be appended to the services listed in appendix p. appendix p is the list of cpt codes for services that are typically performed face-to-face, but may be rendered via a real-time (synchronous) interactive audio and video telecommunications system. | GT | Via interactive audio and video telecommunication systems | SA | Nurse practitioner rendering service in collaboration with a physician | 59 | Distinct procedural service: under certain circumstances, it may be necessary to indicate that a procedure or service was distinct or independent from other non-e/m services performed on the same day. modifier 59 is used to identify procedures/services, other than e/m services, that are not normally reported together, but are appropriate under the circumstances. documentation must support a different session, different procedure or surgery, different site or organ system, separate incision/excision, separate lesion, or separate injury (or area of injury in extensive injuries) not ordinarily encountered or performed on the same day by the same individual. however, when another already established modifier is appropriate it should be used rather than modifier 59. only if no more descriptive modifier is available, and the use of modifier 59 best explains the circumstances, should modifier 59 be used. note: modifier 59 should not be appended to an e/m service. to report a separate and distinct e/m service with a non-e/m service performed on the same date, see modifier 25. | GW | Service not related to the hospice patient's terminal condition | GC | This service has been performed in part by a resident under the direction of a teaching physician | FQ | The service was furnished using audio-only communication technology | GJ | "opt out" physician or practitioner emergency or urgent service | AF | Specialty physician | 93 | Synchronous telemedicine service rendered via telephone or other real-time interactive audio-only telecommunications system : synchronous telemedicine service is defined as a real-time interaction between a physician or other qualified health care professional and a patient who is located away at a distant site from the physician or other qualified health care professional. the totality of the communication of information exchanged between the physician or other qualified health care professional and the patient during the course of the synchronous telemedicine service must be of an amount and nature that is sufficient to meet the key components and/or requirements of the same service when rendered via a face-to-face interaction. | GV | Attending physician not employed or paid under arrangement by the patient's hospice provider | GQ | Via asynchronous telecommunications system | CR | Catastrophe/disaster related | AM | Physician, team member service | GZ | Item or service expected to be denied as not reasonable and necessary | XU | Unusual non-overlapping service, the use of a service that is distinct because it does not overlap usual components of the main service | FR | The supervising practitioner was present through two-way, audio/video communication technology | U6 | Medicaid level of care 6, as defined by each state | 25 | Significant, separately identifiable evaluation and management service by the same physician or other qualified health care professional on the same day of the procedure or other service: it may be necessary to indicate that on the day a procedure or service identified by a cpt code was performed, the patient's condition required a significant, separately identifiable e/m service above and beyond the other service provided or beyond the usual preoperative and postoperative care associated with the procedure that was performed. a significant, separately identifiable e/m service is defined or substantiated by documentation that satisfies the relevant criteria for the respective e/m service to be reported (see evaluation and management services guidelines for instructions on determining level of e/m service). the e/m service may be prompted by the symptom or condition for which the procedure and/or service was provided. as such, different diagnoses are not required for reporting of the e/m services on the same date. this circumstance may be reported by adding modifier 25 to the appropriate level of e/m service. note: this modifier is not used to report an e/m service that resulted in a decision to perform surgery. see modifier 57 for significant, separately identifiable non-e/m services, see modifier 59. | FS | Split (or shared) evaluation and management visit | 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) | HF | Substance abuse program | HO | Masters degree level | AJ | Clinical social worker | XE | Separate encounter, a service that is distinct because it occurred during a separate encounter | HB | Adult program, non geriatric | TD | Rn | UB | Medicaid level of care 11, as defined by each state | AQ | Physician providing a service in an unlisted health professional shortage area (hpsa) | CC | Procedure code change (use 'cc' when the procedure code submitted was changed either for administrative reasons or because an incorrect code was filed) | GK | Reasonable and necessary item/service associated with a ga or gz modifier | PO | Excepted service provided at an off-campus, outpatient, provider-based department of a hospital | U1 | Medicaid level of care 1, as defined by each state | U3 | Medicaid level of care 3, as defined by each state | AR | Physician provider services in a physician scarcity area | CG | Policy criteria applied | GY | Item or service statutorily excluded, does not meet the definition of any medicare benefit or, for non-medicare insurers, is not a contract benefit | HA | Child/adolescent program | HE | Mental health program | Q6 | Service furnished under a fee-for-time compensation arrangement by a substitute physician or by a substitute physical therapist furnishing outpatient physical therapy services in a health professional shortage area, a medically underserved area, or a rural area | UA | Medicaid level of care 10, as defined by each state | V3 | Demonstration modifier 3 | 22 | Increased procedural services: when the work required to provide a service is substantially greater than typically required, it may be identified by adding modifier 22 to the usual procedure code. documentation must support the substantial additional work and the reason for the additional work (ie, increased intensity, time, technical difficulty of procedure, severity of patient's condition, physical and mental effort required). note: this modifier should not be appended to an e/m service. | 24 | Unrelated evaluation and management service by the same physician or other qualified health care professional during a postoperative period: the physician or other qualified health care professional may need to indicate that an evaluation and management service was performed during a postoperative period for a reason(s) unrelated to the original procedure. this circumstance may be reported by adding modifier 24 to the appropriate level of e/m service. | 26 | Professional component: certain procedures are a combination of a physician or other qualified health care professional component and a technical component. when the physician or other qualified health care professional component is reported separately, the service may be identified by adding modifier 26 to the usual procedure number. | 32 | Mandated services: services related to mandated consultation and/or related services (eg, third party payer, governmental, legislative or regulatory requirement) may be identified by adding modifier 32 to the basic procedure. | 76 | Repeat procedure or service by same physician or other qualified health care professional: it may be necessary to indicate that a procedure or service was repeated by the same physician or other qualified health care professional subsequent to the original procedure or service. this circumstance may be reported by adding modifier 76 to the repeated procedure or service. note: this modifier should not be appended to an e/m service. | 77 | Repeat procedure by another physician or other qualified health care professional: it may be necessary to indicate that a basic procedure or service was repeated by another physician or other qualified health care professional subsequent to the original procedure or service. this circumstance may be reported by adding modifier 77 to the repeated procedure or service. note: this modifier should not be appended to an e/m service. | 96 | Habilitative services: when a service or procedure that may be either habilitative or rehabilitative in nature is provided for habilitative purposes, the physician or other qualified health care professional may add modifier 96 to the service or procedure code to indicate that the service or procedure provided was a habilitative service. habilitative services help an individual learn skills and functioning for daily living that the individual has not yet developed, and then keep and/or improve those learned skills. habilitative services also help an individual keep, learn, or improve skills and functioning for daily living. | A5 | Dressing for five wounds | AG | Primary physician | AH | Clinical psychologist | AI | Principal physician of record | F4 | Left hand, fifth digit | G0 | Telehealth services for diagnosis, evaluation, or treatment, of symptoms of an acute stroke | GA | Waiver of liability statement issued as required by payer policy, individual case | GB | Claim being re-submitted for payment because it is no longer covered under a global payment demonstration | GE | This service has been performed by a resident without the presence of a teaching physician under the primary care exception | GP | Services delivered under an outpatient physical therapy plan of care | HK | Specialized mental health programs for high-risk populations | HN | Bachelors degree level | HP | Doctoral level | HW | Funded by state mental health agency | KX | Requirements specified in the medical policy have been met | PD | Diagnostic or related non diagnostic item or service provided in a wholly owned or operated entity to a patient who is admitted as an inpatient within 3 days | Q1 | Routine clinical service provided in a clinical research study that is in an approved clinical research study | Q2 | Demonstration procedure/service | Q5 | Service furnished under a reciprocal billing arrangement by a substitute physician or by a substitute physical therapist furnishing outpatient physical therapy services in a health professional shortage area, a medically underserved area, or a rural area | SC | Medically necessary service or supply | TG | Complex/high tech level of care | TP | Medical transport, unloaded vehicle | U2 | Medicaid level of care 2, as defined by each state | U4 | Medicaid level of care 4, as defined by each state | U5 | Medicaid level of care 5, as defined by each state | U7 | Medicaid level of care 7, as defined by each state | U9 | Medicaid level of care 9, as defined by each state | UC | Medicaid level of care 12, as defined by each state | UD | Medicaid level of care 13, as defined by each state | UF | Services provided in the morning | UG | Services provided in the afternoon | UH | Services provided in the evening | X1 | Continuous/broad services: for reporting services by clinicians, who provide the principal care for a patient, with no planned endpoint of the relationship; services in this category represent comprehensive care, dealing with the entire scope of patient problems, either directly or in a care coordination role; reporting clinician service examples include, but are not limited to: primary care, and clinicians providing comprehensive care to patients in addition to specialty care | X2 | Continuous/focused services: for reporting services by clinicians whose expertise is needed for the ongoing management of a chronic disease or a condition that needs to be managed and followed with no planned endpoint to the relationship; reporting clinician service examples include but are not limited to: a rheumatologist taking care of the patient's rheumatoid arthritis longitudinally but not providing general primary care services | X4 | Episodic/focused services: for reporting services by clinicians who provide focused care on particular types of treatment limited to a defined period and circumstance; the patient has a problem, acute or chronic, that will be treated with surgery, radiation, or some other type of generally time-limited intervention; reporting clinician service examples include but are not limited to, the orthopedic surgeon performing a knee replacement and seeing the patient through the postoperative period | XP | Separate practitioner, a service that is distinct because it was performed by a different practitioner |
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| 2021-01-01 | Note | Guidelines changed. |
| 2017-01-01 | Changed | Long, Medium and Short descriptions changed. |
| 2013-01-01 | Added | Added |
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