HCPCS level II modifiers are used to identify procedure codes that are not included in CPT codes and not covered by list of CPT modifiers. They are used to identify services, supplies or products such durable medical equipment, ambulance services, orthotics, etc.
What Are HCPCS Level II Modifiers?
As mentioned in the introduction, HCPCS Level II Modifiers can be used to identify supplies, products, and/or services which not included in CPT codes.
- durable medical equipment;
- ambulance services; and/or
- supplies (DMEPOS) when they are used outside a Physician’s office.
Level II HCPCS modifiers were established October 2003 to cover a variety of supplies, services or products that are not described by CPT codes so claims to medicare and other insurers can be submitted with these items included.
TIP: You can find the list of CPT modifiers here.
Below you can find the HCPCS Level II Modifiers with descriptions and guidelines.
What is modifier A1? Dressing for one wound.
When to use a A1 modifier? Modifier A1 can be used to identify a surgical dressing a surgical supplier (or health provider) has used for the dressing of a single wound.
What is modifier A2? Dressing for two wounds.
When to use a A2 modifier? Modifier A2 can be used to identify a surgical dressing a surgical supplier (or health provider) has used for the dressing of two wounds.
What is modifier A3? Dressing for three wounds.
When to use a A3 modifier? Modifier A3 can be used to identify a surgical dressing a surgical supplier (or health provider) has used for the dressing of three wounds.
What is modifier A4? Dressing for four wounds.
When to use a A4 modifier? Modifier A2 can be used to identify a surgical dressing a surgical supplier (or health provider) has used for dressing four wounds.
What is modifier A4? Dressing for five wounds.
When to use a A5 modifier? Modifier A2 can be used to identify a surgical dressing a surgical supplier (or health provider) has used for dressing five wounds.
What is modifier A6? Dressing for six wounds.
When to use a A6 modifier? Modifier A2 can be used to identify a surgical dressing a surgical supplier (or health provider) has used for dressing six wounds.
What is modifier A7? Dressing for seven wounds.
When to use a A7 modifier? Modifier A2 can be used to identify a surgical dressing a surgical supplier (or health provider) has used for dressing seven wounds.
What is modifier A8? Dressing for eight wounds.
When to use a A8 modifier? Modifier A2 can be used to identify a surgical dressing a surgical supplier (or health provider) has used for dressing eight wounds.
What is modifier A9? Dressing for nine or more wounds.
When to use a A9 modifier? Modifier A2 can be used to identify a surgical dressing a surgical supplier (or health provider) has used for dressing nine wounds or more.
What is modifier AA? Anesthesia services performed personally by anesthesiologist.
When to use an AA modifier? Modifier AA can be used for anesthesia procedures when the health provider personally performs the anesthesia service without help of others.
What is modifier AD? Medical supervision by a physician: more than four concurrent anesthesia procedures.
When to use an AD modifier? Modifier AD can be used when an anesthesiologist provides medical supervision for four or more overlapping procedures.
What is modifier AE? Registered dietician.
When to use an AE modifier? Modifier AE can be used to for services provided by a nutrition professional.
What is modifier AF? Specialty physician.
When to use an AF modifier? Modifier AF can be used to report services provided by a specialty physician. This modifier is only applicable in a physician scarcity area.
What is modifier AG? Primary physician.
When to use an AG modifier? Modifier AG can be used to report services provided by a primary care physician. This modifier is only applicable in a physician scarcity area.
What is modifier AH? Clinical psychologist.
When to use an AH modifier? Modifier AH can be used to report services provided by a clinical psychologist.
What is modifier AI? Principal physician of record.
When to use an AI modifier? Modifier AI can be used to report services provided by a provider responsible for a patient’s overall care. Report this modifier only for nursing home visits and initial hospital codes.
What is modifier AJ? Clinical social worker.
When to use an AJ modifier? Modifier AJ can be used to report services a clinical social worker provides.
What is modifier AK? Non-participating Physician.
When to use an AK modifier? Modifier AK can be used to report services provided by a non-participating Physician.
What is modifier AM? Physician. Team member service.
When to use an AM modifier? Modifier AM is mainly used to report services provided by a Physician assistant (who is part of the provider’s team) but can also be reported for other members of a provider’s team.
What is modifier AO? Alternate payment method declined by the provider of service.
When to use an AO modifier? Modifier AO can be used on claims and must be appended on each line if a health provider declines participation in an alternate payment method by the payer.
What is modifier AP? Determination of refractive state was not performed in the course of diagnostic ophthalmological examination.
When to use an AP modifier? Modifier AP can be used for eye examination services. Only report his modifier to codes that indicate the reimbursement does not include a fee for the determination of a refractive state.
It is also possible to report this modifier for a process determining the patient’s refractive error and need for lenses or glasses.
What is modifier AQ? A physician providing a service in an unlisted health professional shortage area (HPSA).
When to use an AQ modifier? Modifier AQ can be used to report services that are rendered by the health provider in zip code areas that are not part of the “Health Professional Shortage Area (HPSA).
What is modifier AR? Physician provider services in a Physician scarcity area.
When to use an AR modifier? Modifier AR can be used to report services of a Physician provider in a Physician scarcity area.
What is modifier AS? Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery.
When to use an AS modifier? Modifier AS can be used to report services provided by a health care professional who acts as an assistant during a surgical procedure.
What is modifier AT? Acute treatment (chiropractic claims).
When to use an AT modifier? Modifier AT can be used to report treatment of the acute or chronic spinal subluxation with;
- specific chiropractic manipulative treatment; or
- spinal codes.
Modifier AT should be used when reporting CPT 98940, CPT 98941, or CPT 98942.
This modifier can be used with HCPCS codes that describe the supply for ostomy, tracheostomy, or urological procedures.
Report this modifier with HCPCS codes that describe a prosthetic device, prosthetic or orthotic.
This modifier can be used with HCPCS codes describing items needed for surgical dressing.
What is modifier AX? Item furnished in conjunction with dialysis services.
When to use an AX modifier? Use modifier AX for HCPCS codes or with Healthcare Common Procedure Coding System that identifies the supply associated with dialysis services.
What is modifier AY? Item or service furnished to an ESRD patient that is not for the treatment of ESRD.
When to use an AY modifier? Use this modifier for Healthcare Common Procedure Coding System or HCPCS codes for services or items used for an ESRD patient. Don’t report his code for treatments of ESRD.
What is modifier AZ? For an electronic health record incentive payment, a physician provides a service in a dental health professional shortage area.
When to use an AZ modifier? Use modifier AZ for services provided by a health provider in zip code areas that are part of:
- HPSA to obtain the electronic health record; or
- EHR; or
- a designated dental health professional shortage area; or
- incentive payments.
Modifier AZ is not payable by Medicare.
What is modifier BA? Item furnished in conjunction with parenteral, enteral nutrition (pen) services.
When to use a BA modifier? Use modifier BA if a health provider furnished a service or item in combination with parenteral, enteral nutrition (PEN) services.
What is modifier BL? Special acquisition of blood and blood products.
When to use a BL modifier? Modifier BL can be used for HCPCS codes or the Healthcare Common Procedure Code System to report blood products or the actual blood.
What is modifier BO? Orally administered nutrition, not by feeding tube.
When to use a BO modifier? This modifier could be appended to HCPCS codes or to the enteral nutrition Healthcare Common Procedure Code System if a health provider administered enteral nutrition products to a patient by mouth for enteral nutrition therapy.
Don’t report modifier BO for nutrition products administered by a feeding tube.
What is modifier BP? The beneficiary has been informed of the purchase and rental options and has elected to purchase the item.
When to use a BP modifier? Use modifier BP to indicate that a patient has chosen to buy DME or durable medical equipment. The health provider needs to inform the patient about all the options available for either buying or renting the item.
What is modifier BR? The beneficiary has been informed of the purchase and rental options and has elected to rent the item.
When to use a BR modifier? Modifier BR can be used for a code as an item where the beneficiary chooses to rent the item. The patient needs to be fully informed by the health provider about rental and buying options.
What is modifier BU? The beneficiary has been informed of the purchase and rental options and, after 30 days, has not informed the supplier of his/her decision.
When to use a BU modifier? Modifier BU can be added to a code for durable medical equipment. The patient is fully informed about buying and rental options, but the beneficiary does not notify the supplier of their decision to buy or rent the items for 30 days or more.
What is modifier CA? Procedure is payable only in the inpatient setting when performed emergently on an outpatient who expires before admission.
What is modifier CB? Service ordered by a renal dialysis facility (RDF) physician as part of the ESRD beneficiary’s dialysis benefit, is not part of the composite rate, and is separately reimbursable.
What is modifier CC? Procedure code change (use ‘CC’ when submitted procedure code was changed either for administrative reasons or because an incorrect code was filed).
What is modifier CD? An AMCC test has been ordered by an ESRD facility or MCP physician that is part of the composite rate and is not separately billable.
What is modifier CE? An AMCC test 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.
What is modifier CF? An AMCC test has been ordered by an ESRD facility or MCP physician that is not part of the composite rate and is separately billable.
What is modifier CG? Policy criteria applied.
The CH modifier is the first severity modifier used to identify a patient’s impairment. Use this modifier for patients with 0% impairment.
The CI modifier is the severity modifier and identifies patients with functional impairment of a least 1 % and less than 20%.
The CJ modifier can also be used to identify a patient’s impairment. Use this modifier for patients with 20% impairment and less than 40%.
This is another severity modifier and may be used with a G code for patients with at least 40 % but less than 60%.
The CL modifier is also used to define a patient’s functional impairment. Use this modifier for patients with impairment of at least 60 percent but less than 80 percent.
This modifier can be used for reporting severely impaired patients. It identifies patients with at least 80% but less than 100%.
The CN modifier is the last severity modifier and may be used for completely impaired patients (100%).
What is modifier CO? Outpatient occupational therapy services are furnished in whole or part by an occupational therapy assistant.
What is modifier CQ? Outpatient physical therapy services are furnished in whole or in part by a physical therapist assistant.
What is modifier CR? Catastrophe/disaster-related.
What is modifier CS? Cost-sharing waived for specified covid-19 testing-related services that result in an order from 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.
What is modifier CT? Computed tomography services are furnished using equipment that does not meet each attribute of the national electrical manufacturers association (NEMA) XR-29-2013 standard.
What is modifier DA? Oral health assessment by a licensed health professional other than a dentist.
What is modifier E1? Upper left eyelid.
What is modifier E2? Lower left eyelid.
What is modifier E3? Upper right eyelid.
What is modifier E4? Lower right eyelid.
Report this modifier when a health provider has administered ESA (Erythropoietic Stimulating Agent) to a patient with anemia to stimulate red blood cell production.
What is modifier EB? Erythropoetic stimulating agent (ESA) is administered to treat anemia due to anti-cancer radiotherapy.
When to use an EB modifier? This modifier is used by CMS to gather information to determine the prevalence and severity of anemia associated with cancer therapy.
The clinical and hematologic responses to the institution of antianemia therapy, and.. Read more..
What is modifier EC? Erythropoetic stimulating agent (ESA) is administered to treat anemia, not due to anti-cancer radiotherapy or anti-cancer chemotherapy.
When to use an EC modifier? Modifier EC should only be reported for those covered indications outlined in the LCD for J0881 and J0885 where the anemia being treated is non-chemo/radio induced.
FSCO has discovered that providers.. Read more..
What is modifier ED? Hematocrit level has exceeded 39% (or hemoglobin level exceeded 13.0 g/dl) for three or more consecutive billing cycles immediately before and including the current cycle.
What is modifier EE? Hematocrit level has not exceeded 39% (or hemoglobin level has not exceeded 13.0 g/dl) for three or more consecutive billing cycles immediately before and including the current cycle.
What is modifier EJ? Subsequent claims for a defined course of therapy, e.g., epo, sodium hyaluronate, infliximab.
What is modifier EM? Emergency reserve supply (for ESRD benefit only).
What is modifier EP? Service provided as part of medicaid early periodic screening diagnosis and treatment (EPSDT) program.
What is modifier ER? Items and services are furnished by a provider-based, off-campus emergency department.
What Is An ET Modifier? Emergency treatment.
When to use an ET modifier? Use this modifier to designate a dental procedure performed in an emergency.
What is modifier EX? Expatriate beneficiary.
What is modifier EY? No Physician or other licensed health care provider orders this service or item.
What is modifier F1? Left hand. The second digit.
What is modifier F2? Left hand. The third digit.
What is modifier F3? Left hand. The fourth digit.
What is modifier F4? Left hand. The fifth digit.
What is modifier F5? Right hand. The thumb.
What is modifier F6? Right hand. The second digit.
What is modifier F7? Right hand. The third digit.
What is modifier F8? Right hand. The fourth digit.
What is modifier F9? Right hand. The fifth digit.
What is modifier FA? Left hand. The thumb.
What is modifier FB? Item provided without cost to provider, supplier, or practitioner, or full credit received for the replaced device (examples, but not limited to, covered under warranty, replaced due to defect, free samples).
What is modifier FC? Partial credit received for the replaced device.
What is modifier FP? Service provided as part of family planning program.
What is modifier FQ? The service was furnished using audio-only communication technology.
What is modifier FR? The supervising practitioner was present through two-way audio/video communication technology.
What is modifier FS? Split (or shared) evaluation and management visit.
What is modifier FT? Unrelated E/M (Evaluation & Management) 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).
What is modifier FX? X-ray is taken using film.
The FY modifier can be added to a radiology code if a digital image was made with cassette-based imaging.
What is modifier G0? Telehealth services for diagnosis, evaluation, or treatment of symptoms of an acute stroke.
The G1 modifier may be reported for a hemodialysis patient for a urea reduction ratio reading of less than 60.
The G2 modifier can also be reported for patients with hemodialysis to bill for a URR reading between 60 and 64.9.
Modifier G3 may be used for urea reduction ratio (URR) readings between 65 to 69.9 for hemodialysis patients.
The G4 modifier of HCPCS can also be billed for URR readings. Report this modifier for readings between 70 and 74.9.
The G5 modifier can only be billed if a URR (urea reduction ratio) reading is 75 or more.
The G6 modifier can be used for ESRD patients who undergo less than six dialysis sessions per month.
What is modifier G7? Pregnancy resulting from rape or incest or pregnancy certified by a Physician as life threatening.
What is modifier G8? Monitored anesthesia care (mac) for deep, complex, complicated, or markedly invasive surgical procedures.
What is modifier G9? Monitored anesthesia care for a patient with a history of severe cardio-pulmonary condition.
Use this modifier if the payer needs an ABN because the item or service the patient need is probably not covered by Medicare.
What is modifier GA? Claim being re-submitted for payment because it is no longer covered under a global payment demonstration.
What is modifier GC? This service has been performed in part by a resident under the direction of a teaching Physician.
What is modifier GD? Units of service exceed medically unlikely edit value and represent reasonable and necessary services.
What is modifier GE? This service has been performed by a resident without the presence of a teaching physician under the primary care exception.
What is modifier GF? Non-physician (e.g., nurse practitioner (NP), certified registered nurse anesthetist (CRNA), licensed registered nurse (CR ), clinical nurse specialist (CNS), physician assistant (PA)) services in a critical access hospital.
What is modifier GG? Performance and payment of a screening mammogram and diagnostic mammogram on the same patient, same day.
What is modifier GH? Diagnostic mammogram converted from screening mammogram on same day.
What is modifier GJ? Opted out physician or practitioner emergency or urgent service.
What is modifier GK? Reasonable and necessary item/service associated with a GA or GZ modifier.
What is modifier GL? A medically unnecessary upgrade is provided instead of a non-upgraded item, with no charge and no advance beneficiary notice (ABN).
What is modifier GM? Multiple patients on one ambulance trip.
What is modifier GN? Services are delivered under an outpatient speech language pathology plan of care.
What is modifier GO? Services delivered under an outpatient occupational therapy plan of care.
What is modifier GP? Services delivered under an outpatient physical therapy plan of care.
What is modifier GQ? Via asynchronous telecommunications system.
What is 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.
What is modifier GS? Dosage of erythropoietin stimulating agent has been reduced and maintained in response to hematocrit or hemoglobin level.
What is modifier GT? Via interactive audio and video telecommunication systems.
What is modifier GU? Waiver of liability statement issued as required by payer policy, routine notice.
This hospice modifier can be used for an attending physician who is not paid or employed under an arrangement by the hospice provider of the patient.
This hospice modifier can be used for services unrelated to the hospice patient’s terminal condition.
What is modifier GX? Notice of liability issued, voluntary under payer policy.
What is modifier 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.
What is modifier GZ? Item or service expected to be denied as not reasonable and necessary.
When to use a GZ modifier? The GZ modifier must be used when physicians, practitioners, or suppliers want to indicate that they.. Read more..
What is modifier H9? Court-ordered.
What is modifier HA? Child/adolescent program.
What is modifier HB? Adult program, non geriatric.
What is modifier HC? Adult program, geriatric.
What is modifier HD? Pregnant/parenting women’s program.
What is modifier HE? Mental health program.
What is modifier HF? Substance abuse program.
What is modifier HG? Opioid addiction treatment program.
What is modifier HH? Integrated mental health/substance abuse program.
What is modifier HI? Integrated mental health and intellectual disability/developmental disabilities program.
What is modifier HJ? Employee assistance program.
What is modifier HK? Specialized mental health programs for high-risk populations.
What is modifier HL? Intern.
What is modifier HM? Less than bachelor’s degree level.
What is modifier HN? Bachelor’s degree level.
What is modifier HO? Master’s degree level.
What is modifier HP? Doctoral level.
What is modifier HQ? Group setting (for behavioral health use).
What is modifier HR? Family/couple with the client present.
What is modifier HS? Family/couple without the client present.
What is modifier HT? Multidisciplinary team (for behavioral health use).
What is modifier HU? Funded by a child welfare agency.
What is modifier HV? Funded state addictions agency.
What is modifier HW? Funded by state mental health agency.
What is modifier HX? Funded by county/local agency.
What is modifier HY? Funded by juvenile justice agency.
What is modifier HZ? Funded by criminal justice agency.
What is modifier J1? Competitive acquisition program no-pay submission for a prescription number.
What is modifier J2? Competitive acquisition program, restocking of emergency drugs after emergency administration.
What is modifier J3? Competitive acquisition program (CAP), drug not available through cap as written, reimbursed under average sales price methodology.
What is modifier J4? DMEPOS item subject to DMEPOS competitive bidding program that is furnished by a hospital upon discharge.
What is modifier J5? Off-the-shelf orthotic subject to DMEPOS competitive bidding program that is furnished as part of a physical therapist or occupational therapist professional service.
What is modifier JA? Administered intravenously.
What is modifier JB? Administered subcutaneously.
What is modifier JC? Skin substitute used as a graft.
What is modifier JD? Skin substitute is not used as a graft.
What is modifier JE? Administered via dialysate.
What is modifier JG? Drug or biological acquired with 340b drug pricing program discount.
What is modifier JW? Drug amount discarded/not administered to any patient.
What is modifier K0? Lower extremity prosthesis functional level 0.
What is modifier K1? Lower extremity prosthesis functional level 1.
What is modifier K2? Lower extremity prosthesis functional level 2.
What is modifier K3? Lower extremity prosthesis functional level 3.
What is modifier K4? Lower extremity prosthesis functional level 4.
What is modifier KA? Add on option/accessory for a wheelchair.
What is modifier KB? The beneficiary requested an upgrade for ABN. More than four modifiers identified on the claim
What is modifier KC? Replacement of special power wheelchair interface.
What is modifier KD? Drug or Biological infused through implanted DME.
What is modifier KE? Bid under round one of the DMEPOS competitive bidding program for use with non-competitive bid base equipment.
What is modifier KF? Item designated by FDA as Class III device.
When to use a KF modifier? Modifier KF is a pricing modifier. The HCPCS codes for DME designated as class III devices by the FDA are identified on the DMEPOS fee schedule by the presence of the KF modifier.
The KF Modifier is applicable only for.. Read more..
What is modifier KG? DMEPOS item subject to DMEPOS competitive bidding program number 1.
What is modifier KH? DMEPOS item. Initial claim. Purchase or first month rental.
What is modifier KI? DMEPOS item. Second or third month rental.
What is modifier KJ? DMEPOS item. Parenteral enteral nutrition (PEN) pump or capped rental. Months 4 to 15.
What is modifier KK? DMEPOS item subject to DMEPOS competitive bidding program number 2.
What is modifier KL? DMEPOS item delivered via mail.
When to use a KL modifier? Contract suppliers must use the KL Modifier on all claims for diabetic supply codes furnished via mail order.
Non-contract suppliers furnish mail-order diabetic supplies to beneficiaries who do not live in.. Read more..
What is modifier KM? Replacement of facial prosthesis including new impression/moulage.
When to use a KM modifier? The KM Modifier and KN Modifier are to be used on claims for the replacement of items identified by codes L8040 thru L8047 that are furnished on or after January 1, 2005.
Payment for codes L8040 thru L8047 is based on the.. Read more..
What is modifier KN? Replacement of facial prosthesis including new impression/moulage.
When to use a KN modifier? KM Modifier and KN Modifier are used on claims to replace items identified by HCPCS codes L8040 until L8047.
Payment for codes L8040 thru L8047 is based on the.. Read more..
What is modifier KO? Single drug unit dose formulation.
What is modifier KP? The first drug of a multiple drug unit dose formulation.
What is modifier KQ? Second or subsequent drug of a multiple drug unit dose formulation.
What Is A KR Modifier? Rental item, billing for partial month.
What is modifier KS? Glucose monitor supply for a diabetic beneficiary not treated with insulin.
What is modifier KT? Beneficiary resides in a competitive bidding area and travels outside that competitive bidding area and receives a competitive bid item.
What is modifier KU? DMEPOS item subject to DMEPOS competitive bidding program number 3.
What is modifier KV? DMEPOS item subject to DMEPOS competitive bidding program that is furnished as part of a professional service.
What is modifier KW? DMEPOS item subject to DMEPOS competitive bidding program number 4.
What is modifier KX? Requirements specified in the medical policy have been met.
program number 4.
What is modifier KY? DMEPOS item subject to DMEPOS competitive bidding program number 5.
What is modifier KZ? New coverage not implemented by managed care.
What is modifier LC? Left anterior descending coronary artery.
What is modifier LD? Left anterior descending coronary artery.
What is modifier LL? Lease/rental. Use this modifier when DME equipment rental is to be applied against the purchase price.
What is modifier LM? Left main coronary artery.
What is modifier LR? Laboratory round trip.
What is modifier LS? FDA-monitored intraocular lens implant.
What is modifier LT? Left side. This modifier is used to identify procedures performed on the left side of the body.
What is modifier M2? Medicare secondary payer (MSP).
What is modifier MA? The ordering professional is not required to consult a clinical decision support mechanism due to service being rendered to a patient with a suspected or confirmed emergency medical condition.
What is modifier MB? The ordering professional is not required to consult a clinical decision support mechanism due to the significant hardship exception of insufficient internet access.
What is modifier MC? The ordering professional is not required to consult a clinical decision support mechanism due to the significant hardship exception of electronic health records or clinical decision support mechanism vendor issues.
What is modifier MD? The ordering professional is not required to consult a clinical decision support mechanism due to the significant hardship exception of extreme and uncontrollable circumstances.
What is modifier ME? The order for this service adheres to appropriate use criteria in the clinical decision support mechanism consulted by the ordering professional.
What is modifier MF? The order for this service does not adhere to the appropriate use criteria in the clinical decision support mechanism consulted by the ordering professional.
What is modifier MG? The order for this service does not have applicable appropriate use criteria in the qualified clinical decision support mechanism consulted by the ordering professional.
What is modifier MH? Unknown if ordering professional consulted a clinical decision support mechanism for this service, related information was not provided to the furnishing professional or provider.
What is modifier MS? Six-month maintenance and servicing fee for reasonable and necessary parts and labor which are not covered under any manufacturer or supplier warranty.
What is modifier NB? Nebulizer system. Any type. FDA-cleared for use with a specific drug.
What is modifier NR? New when rented. Use modifier NR when new DME at the rental time is subsequently purchased.
What is modifier NU? New equipment (DME).
What is modifier P1? A normal healthy patient.
What is modifier P2? A patient with mild systemic disease.
What is modifier P3? A patient with severe systemic disease.
What is modifier P4? A patient with a severe systemic disease that is a constant threat to life.
What is modifier P5? A moribund patient is not expected to survive without the operation.
What is modifier P6? A declared brain-dead patient whose organs are being removed for donor purposes.
What is modifier PA? Surgical or other invasive procedure on the wrong body part.
What is modifier PB? Surgical or other invasive procedure on the wrong patient.
What is modifier PC? Wrong surgery or other invasive procedure on a patient.
What is modifier PD? Diagnostic or related non-diagnostic item or service provided in a wholly owned or operated entity to a patient admitted as an inpatient within three days.
What is modifier PI? Positron emission tomography (PET) or pet/computed tomography (CPT) to inform the initial treatment strategy of tumors that are biopsy proven or strongly suspected of being cancerous based on another diagnostic testing.
What is modifier PL? Progressive addition lenses.
What is modifier PM? Post mortem.
What is modifier PN? Non-excepted service is provided at an off-campus, outpatient, provider-based hospital department.
What is modifier PO? Excepted service provided at a hospital’s off-campus, outpatient, provider-based department.
What is modifier PS? Positron emission tomography (PET) or pet/computed tomography (CT) to inform the subsequent treatment strategy of cancerous tumors when the beneficiary’s treating physician determines that the pet study is needed to inform subsequent anti-tumor strategy.
What is modifier PT? Colorectal cancer screening test; converted to diagnostic test or other procedure.
What is modifier Q0? An investigational clinical service that is provided in a clinical research study that is in an approved clinical research study.
What is modifier Q1? A routine clinical service that is provided in a clinical research study that is in an approved clinical research study.
What is modifier Q2? Demonstration procedure or service.
What is modifier Q3? Live kidney donor surgery and related services.
What is modifier Q4? Service for ordering/referring physician qualifies as a service exemption.
What is modifier Q5? Service furnished under a reciprocal billing arrangement by a:
- substitute physician;
- by a substitute physical therapist furnishing outpatient physical therapy services in a:
- health professional shortage area;
- a medically underserved area; or
- a rural area.
What is modifier Q6? A 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.
What is modifier Q7? One class A finding.
What is modifier Q8? Two class B findings.
What is modifier Q9? One class B and two class C findings.
What is modifier QA? Prescribed amounts of stationary oxygen for daytime use while at rest and nighttime use differ; the average of the two amounts is less than one liter per minute (LPM).
What is modifier QB? Prescribed amounts of stationary oxygen for daytime use while at rest and nighttime use differ; the average of the two amounts exceeds four liters per minute (LPM), and portable oxygen is prescribed.
What is modifier QC? Single channel monitoring.
What is modifier QD? Recording and storage in solid state memory by a digital recorder.
What is modifier QE? The prescribed amount of stationary oxygen at rest is less than one liter per minute (LPM).
What is modifier QF? The prescribed amount of stationary oxygen at rest exceeds four liters per minute (LPM), and portable oxygen is prescribed.
What is modifier QG? The prescribed amount of stationary oxygen at rest is greater than 4 Liters per minute (LPM).
What is modifier QH? An oxygen conserving device is being used with an oxygen delivery system.
What is modifier QJ? Services or items provided to a prisoner or patient in state or local custody. However, as applicable, the state or local government meets the requirements in 42 CFR 411.4 (B).
What is modifier QK? The medical direction of two, three, or four concurrent anesthesia procedures involves qualified individuals.
What is modifier QL? The patient was pronounced dead after an ambulance was called.
What is modifier QL? An ambulance service is provided under an arrangement by a provider of services.
What is modifier QN? An ambulance service is furnished directly by a provider of services.
What is modifier QP? Documentation shows that the laboratory test(s) was ordered individually or as a CPT-recognized panel other than automated profile codes CPT 80002 – CPT 80019, CPT G0058, CPT G0059, and CPT G0060.
What is modifier QQ? The ordering professional consulted a qualified clinical decision support mechanism for this service, and the related data was provided to the furnishing professional.
When to use modifier QQ? Modifier QQ can be used when the furnishing professional is aware of the result of the ordering professional’s consultation with a CDSM for that patient.
Modifier QQ is reported on the same claim line as the CPT code for advanced diagnostic imaging.. Read more..
What is modifier QR? Prescribed amounts of stationary oxygen for daytime use while at rest and nighttime use differ, and the average of the two amounts is greater than 4 liters per minute (LPM)
What is modifier QS? Monitored anesthesia care services.
What is modifier QT? Recording and storage on tape by an analog tape recorder.
What is modifier QW? CLIA Waived Test. Effective October 1, 1996, all new waived tests are being assigned a CPT code (instead of a temporary five-digit G- or Q-code).
What is modifier QX? CRNA service with medical direction by a physician.
What is modifier QY? Medical direction of one certified registered nurse anesthetist (CRNA) by an anesthesiologist
What is modifier QZ? CRNA service without medical direction by a Physician.
What is modifier RA? Replacement of a DME, prosthetic or orthotic item.
What is modifier RB? Replacement of a part of a DME, prosthetic or orthotic item furnished as part of a repair.
What is modifier RC? Right coronary artery.
What is modifier RD? Drug provided to the beneficiary. Not administered ‘incident-to’.
What is modifier RE? Furnished in full compliance with a fda-mandated risk evaluation and mitigation strategy (REMS).
What is modifier RI? Ramus intermedius coronary artery.
What is modifier RR? Rental. Use modifier RR when DME is to be rented.
What is modifier RT? Right Side. The RT modifier is used to identify procedures performed on the right side of the body.
What is modifier SA? A nurse practitioner renders service in collaboration with a Physician.
What is modifier SB? Nurse midwife.
What is modifier SC? Medically necessary service or supply.
What is modifier SD? Services provided by registered nurse with specialized, highly technical home infusion training.
What is modifier SE? State and/or federally-funded programs/services.
What is 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).
What is modifier SG? Ambulatory surgical center (ASC) facility service.
What is modifier SH? A second concurrently administered infusion therapy.
What is modifier SJ? A third or more concurrently administered infusion therapy.
What is modifier SK? Member of a high-risk population. Use modifier SK only with codes for immunization).
What is modifier SL? State supplied vaccine.
What is modifier SM? A 2nd surgical opinion.
What is modifier SN? A 3rd surgical opinion.
What is modifier SQ? An item ordered by home health.
What is modifier SS? The home infusion services are provided in the infusion suite of the iv therapy provider.
What is modifier ST? Related to trauma or injury.
What is modifier SU? Procedure performed in physician’s office. Use this modifier to denote the use of facility and equipment.
What is modifier SV? Pharmaceuticals delivered to patient’s home but not utilized.
What is modifier SW? The services are provided by a certified diabetic educator.
What is modifier SY? Persons who are in close contact with members of high-risk populations. Use modifier SY only with codes for immunization.
What is modifier T1? Left foot. The 2nd digit.
What is modifier T2? Left foot. The 3rd digit
What is modifier T3? Left foot. The 4th digit.
What is modifier T4? Left foot. The 5th digit.
What is modifier T5? Right foot. The great toe.
What is modifier T6? Right foot. The 2nd digit.
What is modifier T7? Right foot. The 3rd digit.
What is modifier T8? Right foot. The 4th digit.
What is modifier T9? Right foot. The 5th digit.
What is modifier TA? Left foot. The great toe.
What is modifier TB? Drug or biological acquired with 340b drug pricing program discount. This modifier is used for informational purposes.
What is modifier TC? Technical component only. Use modifier TC to indicate the technical part of a diagnostic procedure performed.
What is modifier TD? Registered Nurse (RN). USe this modifier for behavioral health use.
What is modifier TE? Licensed Practical Nurse (LPN). Use this modifier for behavioral health use.
What is modifier TF? Intermediate level of care.
What is modifier TG? Complex and/or high-tech level of care.
What is modifier TH? Obstetrical treatment and/or services. Postpartum or prenatal.
What Is A TJ Modifier? Program group. Adolescents and/or children. Use this modifier for enhancement payment for foster care children screening exams.
What Is A TK Modifier? Extra member or passenger. Non-ambulance transportation.
What is modifier TL? Early intervention/individualized family service plan (IFSP).
What is modifier TM? Individualized education program (IEP).
What is modifier TN? Rural/outside providers’ customary service area.
What is modifier TP? Medical transport. Unloaded vehicle.
What is modifier TQ? Basic life support transport by a volunteer ambulance provider.
What is modifier TR? School-based individualized education program (IEP) services provided outside the public school district responsible for a student.
What is modifier TS? Follow-up service.
What is modifier TT? Individualized service is provided to more than one patient in the same setting.
What is modifier TU? Special payment rate for overtime.
What is modifier TV? Special payment rates for holidays or weekends.
What is modifier TW? Back-up equipment.
What is modifier U1? Medicaid level of care one. The level is defined by each state.
What is modifier U2? Medicaid level of care two. The level is defined by each state..
What is modifier U3? Medicaid level of care three. The level is defined by each state.
What is modifier U4? Medicaid level of care four. The level is defined by each state.
What is modifier U5? Medicaid level of care five. The level is defined by each state.
What is modifier U6? Medicaid level of care six. The level is defined by each state.
What is modifier U7? Medicaid level of care seven. The level is defined by each state.
What is modifier U8? Medicaid level of care eight. The level is defined by each state.
What is modifier U9? Medicaid level of care nine. The level is defined by each state.
What is modifier UA? Medicaid level of care ten. The level is defined by each state.
What is modifier UB? Medicaid level of care eleven. The level is defined by each state.
What is modifier UC? Medicaid level of care twelve. The level is defined by each state.
What is modifier UD? Medicaid level of care thirteen. The level is defined by each state.
What is modifier UE? Used durable medical equipment.
What is modifier UF? Services provided in the morning.
What is modifier UG? Services provided in the afternoon.
What is modifier UH? Services provided in the evening.
What is modifier UJ? Services provided at night.
What is modifier UK? Services provided on behalf of the client to someone other than the client. This modifier can be used for collateral relationship.
What is modifier UN? Two patients for portable X-rays.
What is modifier UP? Three patients for portable X-rays.
What is modifier UQ? Four patients for portable X-rays.
What is modifier UR? Five patients for portable X-rays.
What is modifier US? Six or more patients for portable X-rays.
What is modifier V1? Demonstration modifier one.
What is modifier V2? Demonstration modifier two.
What is modifier V3? Demonstration modifier three.
What is modifier V4? Demonstration modifier four.
This modifier can be used by providers to report the use of a vascular catheter during a hemodialysis procedure on a patient with ESRD.
Report the V6 modifier if a provider used a arteriovenous graft, or other vascular access, during a hemodialysis procedure on a patient with ESRD.
The V7 modifier is used to arteriovenous fistula only in use with two needles during a hemodialysis procedure on an ESRD patient.
What is modifier VM? Medicare diabetes prevention program (MDPP) virtual make-up session.
What is modifier VP? Aphakic patient.
What is modifier X1? Continuous or broad services.
What is modifier X2? Continuous or focused services.
What is modifier X3? Episodic or broad services.
What is modifier X4? Episodic or focused services.
What is modifier X5? Diagnostic services requested by another clinician.
This modifier can be used for distinct services that occurred on a separate encounter on the same day.
This modifier can be reported for a distinct procedure because it was performed on a separate structure or organ.
This modifier can also be used for distinct services if performed by a different practitioner.
The XU modifier can be billed for unusual non-overlapping services that do not overlap the usual components of the main service.