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Try CasePilotCPT 99239 represents the higher-level hospital discharge management code, used when the physician spends more than 30 minutes managing the final discharge of a hospitalized or observation patient. It is the counterpart to 99238 (30 minutes or less). Since the 2023 CPT restructuring, both codes apply uniformly to inpatient and observation patients—the prior observation-only discharge code (99217) was deleted.
Discharge day management is a uniquely time-driven service. Unlike subsequent hospital visit codes (99231–99233), there is no MDM pathway for 99239.
The code is selected based solely on how long the physician personally spent on discharge-related activities on the date of the encounter. This makes thorough, explicit time documentation both critical and non-negotiable.
flowchart TD
A[Patient being discharged] --> B{Same-day admission<br/>and discharge?}
B -->|Yes| C{8+ hours in<br/>hospital?}
C -->|Yes| D[Bill 99234-99236<br/>based on MDM or time]
C -->|No| E[Bill 99221-99223<br/>initial care only]
B -->|No| F{Are you the attending/<br/>admitting physician?}
F -->|No| G[Bill 99231-99233<br/>subsequent visit]
F -->|Yes| H{Total physician time<br/>on discharge date?}
H -->|30 min or less| I[Bill 99238]
H -->|More than 30 min| J[Bill 99239<br/>Document exact minutes]
CPT 99239 is selected exclusively by time. The CPT manual states clearly: discharge management codes 99238 and 99239 are time-based only. To report 99239, the physician must spend more than 30 minutes on the date of the encounter on discharge-related activities. Time need not be continuous—it can be accumulated throughout the day, as long as all time counted is on the same calendar date and personally performed by the physician.
Per CPT 2025/2026 guidelines (unchanged for 2026), the following physician activities count toward the total time threshold :
Critical Exclusions — Do not include the following in your time statement:
The “More Than 30 Minutes” Trap: Documenting exactly “30 minutes” or “approximately 30 minutes” is insufficient for CPT 99239. The code requires the threshold be exceeded. Your note must reflect something like “31 minutes,” “35 minutes,” or “approximately 40 minutes.” Documentation auditors consistently flag vague time statements, and this is the #1 reason 99239 is downgraded to 99238 on audit.
The CPT descriptor defines 99239 as the physician’s total time on the date of encounter for final hospital or observation discharge. Specifically, the code covers all of the following services when performed on the day of discharge :
Because all of these services are bundled into the single discharge code, the attending physician cannot separately bill for prescription writing, referral completion, or discharge instruction time under other codes on the same day. The discharge code encompasses all E/M work by the attending on the date of discharge.
The most common reason 99239 is denied, downgraded, or recouped on audit is inadequate or ambiguous time documentation. Based on FCSO Medicare improper payment findings, the two primary deficiencies are: (1) no time statement at all, and (2) a time statement that does not clearly exceed 30 minutes. The following standards make a note audit-resistant.
Instead of: “Patient discharged home. Discharge instructions given. 30 minutes spent.”
Write: “Patient examined at bedside. Final examination performed; wound healing appropriately, no signs of infection. Discharge instructions reviewed with patient and spouse, including medication changes (new anticoagulant started, NSAID discontinued), activity restrictions, follow-up with PCP within 7 days, and return precautions. Discharge summary dictated, prescription for rivaroxaban provided, and referral form completed for cardiology follow-up. Total time personally spent on discharge activities today: 38 minutes.”
If a resident performs part of the discharge under supervision, the attending must document personal involvement in and oversight of the key portions of the discharge. Under Teaching Physician rules, the attending’s note must reflect their personal participation. Modifier GC is required on the claim. The time counted for code selection must reflect the teaching physician’s personal time, not the resident’s time.
Per CMS guidelines and CPT, only one physician may bill the hospital discharge management service per patient per hospital stay—and it must be the attending/admitting physician of record, or a designated covering physician.
If the admitting physician’s partner performs the discharge due to call coverage or scheduling, billing under the discharging physician’s NPI is appropriate, provided the care was formally transferred or the discharging physician is covering for the same group. The billing date must reflect the actual date of the face-to-face discharge visit.
Consultants and specialists who did not admit the patient CANNOT bill 99239, even if they visit the patient on the discharge date. A cardiologist seeing a patient for rounds on the day of discharge bills a subsequent inpatient visit (99231–99233), not a discharge code. Only the attending physician of record performing the actual discharge process bills 99238 or 99239.
In the event of patient death, the physician who personally performs the pronouncement of death may bill 99238 or 99239 for that service. The billing date must reflect the calendar date on which the pronouncement was performed, even if paperwork is finalized on a subsequent date.
Only one hospital discharge day management service (99238 or 99239) is payable per patient, per hospital stay. If a patient is readmitted within the same hospitalization (e.g., transferred to ICU and back to floor), only one discharge management service is payable for the final discharge of that stay. Medicare will deny a second 99239 for the same admission.
If the patient is both admitted and discharged on the same calendar date with a minimum of 8 hours of hospital care, use CPT 99234–99236 (Hospital Inpatient or Observation Care Services, including admission and discharge on the same date). Do not use 99239 in this scenario. If admission and discharge are on the same day but fewer than 8 hours elapsed, use the appropriate initial care code (99221–99223) only.
The discharge code replaces any subsequent hospital visit code on the day of discharge. The attending physician cannot bill both 99232 and 99239 on the same date of service. The discharge code covers all E/M services provided by the attending on that day. If time spent reviewing labs, making medication decisions, and completing the physical discharge pushes the encounter over 30 minutes in total, 99239 is the appropriate and only E/M code for the day.
When a patient is discharged from a hospital and admitted to a skilled nursing facility on the same day, Medicare will pay both the hospital discharge code (99238 or 99239) and the SNF initial care code when billed by the same physician with the same date of service. These are considered distinct and separately payable services.
Since CPT’s 2023 restructuring, the old observation discharge code (99217) has been deleted. CPT 99238 and 99239 now apply to both inpatient and observation discharges uniformly—eliminating the prior need to distinguish between the two status types when coding the discharge event. If the patient was in observation status and was never formally admitted as inpatient, 99239 still applies when the discharge time exceeds 30 minutes and the discharge occurs on a date other than the observation admission date.
For CY 2026, CMS established two separate conversion factors for the first time: $33.57 for qualifying APM participants and $33.40 for all other physicians, representing increases of 3.77% and 3.26% respectively over 2025. Importantly, E/M codes—including 99238 and 99239—are exempt from CMS’s new 2.5% efficiency adjustment applied to non-time-based procedural codes. This means discharge management code reimbursements are positively impacted by the conversion factor increase without any offsetting downward efficiency adjustment.
While 99239 is a time-based code and does not require a specific diagnosis to qualify, the following ICD-10 codes are frequently associated with discharges that legitimately exceed 30 minutes due to their inherent complexity, required patient education, or extensive care coordination needs:
A surgeon who is also the attending physician may need to use Modifier 24 when the discharge service relates to a problem that is entirely unrelated to the surgical procedure being managed under a global period. Example: An orthopedic surgeon who admitted a patient for a hip replacement is also the attending managing a concurrent pneumonia that complicates the discharge. If the discharge is driven primarily by the unrelated medical problem, Modifier 24 appended to 99239 signals to payers that this is outside the global surgical package. Routine post-op follow-up within the global period is not separately billable.
Modifier 25 would be applicable in the rare scenario where a distinct, separately identifiable procedure (e.g., removal of a chest tube, wound debridement) is performed on the same day as the discharge. In this case, Modifier 25 appended to 99239 signals that the discharge management service was a significant, separately identifiable E/M service beyond the procedural service performed that day. Time counted for 99239 must not overlap with the time/work captured under the procedure code.
When a resident is involved in the discharge under supervision of the teaching physician, Modifier GC must be appended to 99239. The teaching physician must document their personal presence for the key portions of the discharge (the physical examination, discussion with patient, and discharge plan), and the time documented for code selection must reflect only the teaching physician’s personal time, not the resident’s independent time.
When a discharge is performed as a split/shared service by a physician and a non-physician practitioner (NPP) in the same group, Modifier FS must be appended to the claim for Medicare. The code is billed under the provider who performed the substantive portion (more than 50% of the total time, or the provider who made/approved the medical decision making and plan).
Beginning January 1, 2024, both CMS and CPT aligned their definitions for split/shared E/M services. These rules remain unchanged for 2025 and 2026. For discharge codes, split/shared billing follows the same substantive-portion framework applied to other hospital E/M codes.
The provider who performed the substantive portion bills 99239. The substantive portion is defined as either:
Because 99239 is inherently time-based, time is typically the most relevant substantive-portion determination method for split/shared discharge encounters. If the NPP spent 25 minutes and the physician spent 10 minutes, the NPP would be the appropriate billing provider (NPP rate applies). If the physician spent 20 minutes and the NPP spent 15 minutes, the physician bills and Modifier FS is required for Medicare claims.
Important: Medicare requires that both the physician and NPP be enrolled in Medicare and have E/M services within their scope of practice. The note must reflect which provider performed which activities and each provider’s time contribution. A physician’s signature alone on a shared note is not sufficient documentation for billing at the physician rate.
| Code | Time Threshold | Scenario | Key Rules |
|---|---|---|---|
| 99238 | 30 minutes or less on the date of the encounter | Routine, straightforward discharge. Patient is medically stable, instructions are brief, minimal coordination needed. Discharge summary short. Prescriptions reviewed quickly. | Time does NOT need to be explicitly documented. No time threshold to prove — any discharge activity on the date qualifies. Face-to-face required. |
| 99239 | More than 30 minutes on the date of the encounter | Complex discharge requiring extensive patient/family counseling, multiple prescription adjustments, care coordination (SNF, home health, specialist follow-ups), lengthy discharge summary, or complex social barriers to discharge. | Time must be explicitly documented as exceeding 30 minutes. “More than 30 minutes” or the exact total (e.g., “38 minutes”) is required. This is the most common audit deficiency. |
| 99234–99236 | MDM-based (Straightforward/Low, Moderate, or High) or Time-based (45, 70, or 85+ minutes) | Patient admitted and discharged on the same calendar date with a minimum of 8 hours in observation or inpatient status. | Only the principal physician of record who wrote both the admission and discharge notes bills this code set. Cannot be used when the patient was in observation fewer than 8 hours on a single date. |
Patient: 74-year-old discharged after 5-day admission for acute on chronic systolic heart failure decompensation. Activities on Discharge Day: Physician reviews morning BNP and renal function (10 min), performs final bedside exam (8 min), counsels patient and daughter on new medication regimen — furosemide dose increase, new spironolactone, metoprolol titration, ARNI transition (12 min), completes discharge summary and medication reconciliation in EHR (8 min). Total time: 38 minutes. Documentation: “Total physician time spent on discharge activities today: 38 minutes, including chart review, bedside examination, patient/family counseling on new heart failure regimen, and discharge summary documentation.” Coding: 99239. Rationale: Time exceeds 30 minutes and is explicitly documented. All activities are discharge-related and personally performed by the physician.
Patient: 68-year-old being discharged to inpatient rehabilitation after ischemic stroke with residual right-sided weakness. Activities: Final neurological examination (10 min), review of rehabilitation placement options and coordination with case management and the receiving rehabilitation facility (15 min), family meeting to discuss long-term expectations, driving restrictions, and return precautions (10 min), prescription for dual antiplatelet therapy and statin written, neurology follow-up referral completed (8 min). Total time: 43 minutes. Coding: 99239. Rationale: Complex neurological discharge requiring extensive care coordination and family counseling justifies time well exceeding 30 minutes. Family/caregiver instruction time counts toward total time.
Setup: Hospital medicine PA conducts the discharge examination, provides medication instructions, and completes the discharge summary (25 min). The supervising hospitalist then reviews the plan, reviews the note, adds clinical nuance to the medication reconciliation, and personally counsels the patient on a new anticoagulant (15 min). Total combined time: 40 minutes; Physician time: 15 min; PA time: 25 min. Substantive portion: The PA spent more than 50% of the total time. The PA is the billing provider at the NPP rate. Coding: 99239 with Modifier FS (billed under PA’s NPI, physician’s NPI in referring field). Rationale: Under 2024–2026 split/shared rules, the PA performed the substantive portion by time. Modifier FS is required for Medicare. Documentation must record both providers’ individual time contributions.
Setup: Patient admitted for end-stage COPD exacerbation passes away on hospital day 4. The attending physician is called to the bedside to perform the pronouncement of death, counsel the family, complete the death certificate, and dictate a discharge summary. Total physician time: 45 minutes. Coding: 99239 (date of actual pronouncement). Rationale: Only the physician who personally performs the pronouncement may bill. The billing date reflects the calendar date of the pronouncement, even if paperwork is completed the following day. Time exceeds 30 minutes and should be documented explicitly.
Setup: Patient being discharged from inpatient stay for hip fracture repair and admitted to a skilled nursing facility on the same date. The attending physician spends 35 minutes on the hospital discharge (final examination, discharge summary, coordination with SNF staff) and then bills a separate SNF admission code. Coding: 99239 (hospital discharge) + SNF initial care code (e.g., 99306), same date of service. Rationale: CMS explicitly allows both the hospital discharge code and a nursing facility admission code on the same date when billed by the same physician. These are distinct, separately payable services.
Per FCSO Medicare and CMS Recovery Audit data, the following are the most frequently cited deficiencies in hospital discharge day management claims :
| Error Type | Description | Correction |
|---|---|---|
| No time documented | Physician bills 99239 with no time statement in the note at all. | Always include explicit total minutes in the discharge note. 99238 does not require a time statement; 99239 does. |
| Time of exactly “30 minutes” | Note says “30 minutes spent discharging patient.” This only satisfies 99238. | Document the actual time spent. If it exceeds 30 minutes, state “31 minutes,” “35 minutes,” or the exact figure. |
| Including staff time | Physician includes time spent by nurses providing discharge education or by case managers arranging post-acute care. | Count only personally performed physician (or NPP) time. Clinical staff time is not countable. |
| Carrying over time from prior day | Physician includes time spent on the patient the day before discharge in the discharge time total. | Only same-calendar-date activities count. Prior day’s work cannot be included in 99239 time. |
| Billing 99239 on same-day admit/discharge | Patient admitted and discharged on the same date; attending bills 99239 instead of 99234–99236. | For same-calendar-date admissions with 8+ hours in hospital, use 99234–99236. For under 8 hours, use 99221–99223 only. |
| Consultant billing 99239 | A subspecialist visits the patient on discharge day and bills 99239. | Only the attending/admitting physician of record bills discharge day management. Consultants bill subsequent hospital care (99231–99233). |
| No face-to-face encounter | Discharge managed remotely (by phone or through nursing); no in-person exam documented. | A face-to-face encounter is required for both 99238 and 99239. The discharge cannot be managed entirely without a bedside visit. |
| Billing 99239 + 99232 same day | Attending rounds in the morning and bills 99232, then performs the discharge later and adds 99239. | The discharge code covers all E/M by the attending on the discharge date. The subsequent visit code is bundled. Bill only 99239 for the day. |
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| Short Descr | HOSP IP/OBS DSCHRG MGMT >30 | Medium Descr | HOSPITAL IP/OBS DISCHARGE DAY MGMT > 30 MIN | Long Descr | Hospital inpatient or observation discharge day management; more than 30 minutes on the date of the encounter | Status Code | Active Code | Global Days | XXX - Global Concept Does Not Apply | 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) | 0 - Payment restriction for assistants at surgery applies to this procedure... | 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 | Code Not Recognized by OPPS when submitted on Outpatient Hospital Part B Bill Type (12x/13x) | Type of Service (TOS) | 1 - Medical Care | Berenson-Eggers TOS (BETOS) | M2B - Hospital visit - subsequent | MUE | 1 | CCS Clinical Classification | 227 - Other diagnostic procedures (interview, evaluation, consultation) |
This is a primary code that can be used with these additional add-on codes.
| 90833 | Telehealth Service (Medicare) Addon Code Telemedicine Service (AMA) Audio-Only Telemedicine (AMA) MPFS Status: Active Code APC N Psychotherapy, 30 minutes with patient when performed with an evaluation and management service (List separately in addition to the code for primary procedure) | 90836 | Telehealth Service (Medicare) Addon Code Telemedicine Service (AMA) Audio-Only Telemedicine (AMA) MPFS Status: Active Code APC N Psychotherapy, 45 minutes with patient when performed with an evaluation and management service (List separately in addition to the code for primary procedure) | 90838 | Telehealth Service (Medicare) Addon Code Telemedicine Service (AMA) Audio-Only Telemedicine (AMA) MPFS Status: Active Code APC N Psychotherapy, 60 minutes with patient when performed with an evaluation and management service (List separately in addition to the code for primary procedure) | 96160 | Telehealth Service (Medicare) Add-on Code Telemedicine Service (AMA) Audio-Only Telemedicine (AMA) MPFS Status: Active Code APC S Administration of patient-focused health risk assessment instrument (eg, health hazard appraisal) with scoring and documentation, per standardized instrument | 96161 | Telehealth Service (Medicare) Add-on Code Telemedicine Service (AMA) Audio-Only Telemedicine (AMA) MPFS Status: Active Code APC S Administration of caregiver-focused health risk assessment instrument (eg, depression inventory) for the benefit of the patient, with scoring and documentation, per standardized instrument |
| GC | This service has been performed in part by a resident under the direction of a teaching physician | X3 | Episodic/broad services: for reporting services by clinicians who have broad responsibility for the comprehensive needs of the patient that is limited to a defined period and circumstance such as a hospitalization; reporting clinician service examples include but are not limited to the hospitalist's services rendered providing comprehensive and general care to a patient while admitted to the hospital | FS | Split (or shared) evaluation and management visit | GV | Attending physician not employed or paid under arrangement by the patient's hospice provider | GW | Service not related to the hospice patient's terminal condition | 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. | AQ | Physician providing a service in an unlisted health professional shortage area (hpsa) | AI | Principal physician of record | CR | Catastrophe/disaster related | CS | Cost-sharing waived for specified covid-19 testing-related services that result in and order for or administration of a covid-19 test and/or used for cost-sharing waived preventive services furnished via telehealth in rural health clinics and federally qualified health centers during the covid-19 public health emergency | 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 | 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 | 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. | 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. | CC | Procedure code change (use 'cc' when the procedure code submitted was changed either for administrative reasons or because an incorrect code was filed) | GF | Non-physician (e.g. nurse practitioner (np), certified registered nurse anesthetist (crna), certified registered nurse (crn), clinical nurse specialist (cns), physician assistant (pa)) services in a critical access hospital | AG | Primary physician | Q1 | Routine clinical service provided in a clinical research study that is in an approved clinical research study | AO | Alternate payment method declined by provider of service | AF | Specialty physician | SA | Nurse practitioner rendering service in collaboration with a physician | GT | Via interactive audio and video telecommunication systems | 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 | ET | Emergency services | AM | Physician, team member service | CG | Policy criteria applied | 57 | Decision for surgery: an evaluation and management service that resulted in the initial decision to perform the surgery may be identified by adding modifier 57 to the appropriate level of 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. | AK | Non participating physician | F5 | Right hand, thumb | 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 | 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. | 27 | Multiple outpatient hospital e/m encounters on the same date: for hospital outpatient reporting purposes, utilization of hospital resources related to separate and distinct e/m encounters performed in multiple outpatient hospital settings on the same date may be reported by adding modifier 27 to each appropriate level outpatient and/or emergency department e/m code(s). this modifier provides a means of reporting circumstances involving evaluation and management services provided by physician(s) in more than one (multiple) outpatient hospital setting(s) (eg, hospital emergency department, clinic). note: this modifier is not to be used for physician reporting of multiple e/m services performed by the same physician on the same date. for physician reporting of all outpatient evaluation and management services provided by the same physician on the same date and performed in multiple outpatient setting(s) (eg, hospital emergency department, clinic), see evaluation and management, emergency department, or preventive medicine services codes. | 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. | 51 | Multiple procedures: when multiple procedures, other than e/m services, physical medicine and rehabilitation services or provision of supplies (eg, vaccines), are performed at the same session by the same individual, the primary procedure or service may be reported as listed. the additional procedure(s) or service(s) may be identified by appending modifier 51 to the additional procedure or service code(s). note: this modifier should not be appended to designated "add-on" codes (see appendix d). | 58 | Staged or related procedure or service by the same physician or other qualified health care professional during the postoperative period: it may be necessary to indicate that the performance of a procedure or service during the postoperative period was: (a) planned or anticipated (staged); (b) more extensive than the original procedure; or (c) for therapy following a surgical procedure. this circumstance may be reported by adding modifier 58 to the staged or related procedure. note: for treatment of a problem that requires a return to the operating/procedure room (eg, unanticipated clinical condition), see modifier 78. | 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. | 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. | 79 | Unrelated procedure or service by the same physician or other qualified health care professional during the postoperative period: the individual may need to indicate that the performance of a procedure or service during the postoperative period was unrelated to the original procedure. this circumstance may be reported by using modifier 79. (for repeat procedures on the same day, see modifier 76.) | 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. | 97 | Rehabilitative services: when a service or procedure that may be either habilitative or rehabilitative in nature is provided for rehabilitative purposes, the physician or other qualified health care professional may add modifier 97 to the service or procedure code to indicate that the service or procedure provided was a rehabilitative service. rehabilitative services help an individual keep, get back, or improve skills and functioning for daily living that have been lost or impaired because the individual was sick, hurt, or disabled. | 99 | Multiple modifiers: under certain circumstances 2 or more modifiers may be necessary to completely delineate a service. in such situations modifier 99 should be added to the basic procedure, and other applicable modifiers may be listed as part of the description of the service. | A1 | Dressing for one wound | A5 | Dressing for five wounds | AP | Determination of refractive state was not performed in the course of diagnostic ophthalmological examination | AR | Physician provider services in a physician scarcity area | AS | Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery | CA | Procedure payable only in the inpatient setting when performed emergently on an outpatient who expires prior to admission | ER | Items and services furnished by a provider-based, off-campus emergency department | F1 | Left hand, second digit | F2 | Left hand, third digit | FA | Left hand, thumb | FP | Service provided as part of family planning program | FR | The supervising practitioner was present through two-way, audio/video communication technology | FT | Unrelated evaluation and management (e/m) visit on the same day as another e/m visit or during a global procedure (preoperative, postoperative period, or on the same day as the procedure, as applicable). (report when an e/m visit is furnished within the global period but is unrelated, or when one or more additional e/m visits furnished on the same day are unrelated) | G1 | Most recent urr reading of less than 60 | GA | Waiver of liability statement issued as required by payer policy, individual case | GE | This service has been performed by a resident without the presence of a teaching physician under the primary care exception | GJ | "opt out" physician or practitioner emergency or urgent service | GQ | Via asynchronous telecommunications system | GX | Notice of liability issued, voluntary under payer policy | 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 | GZ | Item or service expected to be denied as not reasonable and necessary | HB | Adult program, non geriatric | HL | Intern | JZ | Zero drug amount discarded/not administered to any patient | KI | Dmepos item, second or third month rental | KV | Dmepos item subject to dmepos competitive bidding program that is furnished as part of a professional service | KX | Requirements specified in the medical policy have been met | LT | Left side (used to identify procedures performed on the left side of the body) | N2 | Group 2 oxygen coverage criteria 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 | PN | Non-excepted service provided at an off-campus, outpatient, provider-based department of a hospital | PO | Excepted service provided at an off-campus, outpatient, provider-based department of a hospital | Q0 | Investigational clinical service provided in a clinical research study that is in an approved clinical research study | Q3 | Live kidney donor surgery and related services | 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) | RT | Right side (used to identify procedures performed on the right side of the body) | SS | Home infusion services provided in the infusion suite of the iv therapy provider | ST | Related to trauma or injury | SV | Pharmaceuticals delivered to patient's home but not utilized | T5 | Right foot, great toe | TH | Obstetrical treatment/services, prenatal or postpartum | TR | School-based individualized education program (iep) services provided outside the public school district responsible for the student | U2 | Medicaid level of care 2, as defined by each state | U6 | Medicaid level of care 6, as defined by each state | U7 | Medicaid level of care 7, as defined by each state | UA | Medicaid level of care 10, as defined by each state | UB | Medicaid level of care 11, 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 | 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 | X5 | Diagnostic services requested by another clinician: for reporting services by a clinician who furnishes care to the patient only as requested by another clinician or subsequent and related services requested by another clinician; this modifier is reported for patient relationships that may not be adequately captured by the above alternative categories; reporting clinician service examples include but are not limited to, the radiologist's interpretation of an imaging study requested by another clinician | XE | Separate encounter, a service that is distinct because it occurred during a separate encounter | XP | Separate practitioner, a service that is distinct because it was performed by a different practitioner | XU | Unusual non-overlapping service, the use of a service that is distinct because it does not overlap usual components of the main service |
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Action
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Notes
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| 2024-01-01 | Changed | Guideline information changed. |
| 2023-01-01 | Changed | Code description changed. |
| 2013-01-01 | Changed | Guideline information changed. Also "by the physician" was removed per AMA 2013 corrections document. |
| 1996-01-01 | Added | First appearance in code book in 1996. |
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