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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.
Examples are:
- prosthetics;
- orthotics;
- 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.
Modifier A1
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.
Modifier A2
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.
Modifier A3
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.
Modifier A4
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.
Modifier A5
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.
Modifier A6
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.
Modifier A7
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.
Modifier A8
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.
Modifier A9
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.
Modifier AA
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.
Modifier AD
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.
Modifier AE
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.
Modifier AF
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.
Modifier AG
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.
Modifier AH
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.
Modifier AI
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.
Modifier AJ
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.
Modifier AK
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.
Modifier AM
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.
Modifier AO
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.
Modifier AP
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.
Modifier AQ
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).
Modifier AR
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.
Modifier AS
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.
Modifier AT
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;
- CMT
- 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.
Modifier AX
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.
Modifier AY
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.
Modifier AZ
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.
Modifier BA
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.
Modifier BL
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.
Modifier BO
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.
Modifier BP
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.
Modifier BR
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.
Modifier BU
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.
Modifier CA
What is modifier CA? Procedure is payable only in the inpatient setting when performed emergently on an outpatient who expires before admission.
Modifier CB
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.
Modifier CC
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).
Modifier CD
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.
Modifier CE
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.
Modifier CF
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.
Modifier CG
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%).
Modifier CO
What is modifier CO? Outpatient occupational therapy services are furnished in whole or part by an occupational therapy assistant.
Modifier CQ
What is modifier CQ? Outpatient physical therapy services are furnished in whole or in part by a physical therapist assistant.
Modifier CR
What is modifier CR? Catastrophe/disaster-related.
Modifier CS
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.
Modifier CT
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.
Modifier DA
What is modifier DA? Oral health assessment by a licensed health professional other than a dentist.
Modifier E1
What is modifier E1? Upper left eyelid.
Modifier E2
What is modifier E2? Lower left eyelid.
Modifier E3
What is modifier E3? Upper right eyelid.
Modifier E4
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.
Modifier EB
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..
Modifier EC
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..
Modifier ED
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.
Modifier EE
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.
Modifier EJ
What is modifier EJ? Subsequent claims for a defined course of therapy, e.g., epo, sodium hyaluronate, infliximab.
Modifier EM
What is modifier EM? Emergency reserve supply (for ESRD benefit only).
Modifier EP
What is modifier EP? Service provided as part of medicaid early periodic screening diagnosis and treatment (EPSDT) program.
Modifier ER
What is modifier ER? Items and services are furnished by a provider-based, off-campus emergency department.
Modifier ET
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.
Modifier EX
What is modifier EX? Expatriate beneficiary.
Modifier EY
What is modifier EY? No Physician or other licensed health care provider orders this service or item.
Modifier F1
What is modifier F1? Left hand. The second digit.
Modifier F2
What is modifier F2? Left hand. The third digit.
Modifier F3
What is modifier F3? Left hand. The fourth digit.
Modifier F4
What is modifier F4? Left hand. The fifth digit.
Modifier F5
What is modifier F5? Right hand. The thumb.
Modifier F6
What is modifier F6? Right hand. The second digit.
Modifier F7
What is modifier F7? Right hand. The third digit.
Modifier F8
What is modifier F8? Right hand. The fourth digit.
Modifier F9
What is modifier F9? Right hand. The fifth digit.
Modifier FA
What is modifier FA? Left hand. The thumb.
Modifier FB
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).
Modifier FC
What is modifier FC? Partial credit received for the replaced device.
Modifier FP
What is modifier FP? Service provided as part of family planning program.
Modifier FQ
What is modifier FQ? The service was furnished using audio-only communication technology.
Modifier FR
What is modifier FR? The supervising practitioner was present through two-way audio/video communication technology.
Modifier FS
What is modifier FS? Split (or shared) evaluation and management visit.
Modifier FT
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).
Modifier FX
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.
Modifier G0
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.
Modifier G7
What is modifier G7? Pregnancy resulting from rape or incest or pregnancy certified by a Physician as life threatening.
Modifier G8
What is modifier G8? Monitored anesthesia care (mac) for deep, complex, complicated, or markedly invasive surgical procedures.
Modifier G9
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.
Modifier GA
What is modifier GA? Claim being re-submitted for payment because it is no longer covered under a global payment demonstration.
Modifier GC
What is modifier GC? This service has been performed in part by a resident under the direction of a teaching Physician.
Modifier GD
What is modifier GD? Units of service exceed medically unlikely edit value and represent reasonable and necessary services.
Modifier GE
What is modifier GE? This service has been performed by a resident without the presence of a teaching physician under the primary care exception.
Modifier GF
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.
Modifier GG
What is modifier GG? Performance and payment of a screening mammogram and diagnostic mammogram on the same patient, same day.
Modifier GH
What is modifier GH? Diagnostic mammogram converted from screening mammogram on same day.
Modifier GJ
What is modifier GJ? Opted out physician or practitioner emergency or urgent service.
When to use a GJ modifier? Use the GJ modifier with the procedure code to identify services that were emergency or urgent when there.. Read more..
Modifier GK
What is modifier GK? Reasonable and necessary item/service associated with a GA or GZ modifier.
Modifier GL
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).
Modifier GM
What is modifier GM? Multiple patients on one ambulance trip.
Modifier GN
What is modifier GN? Services are delivered under an outpatient speech language pathology plan of care.
Modifier GO
What is modifier GO? Services delivered under an outpatient occupational therapy plan of care.
Modifier GP
What is modifier GP? Services delivered under an outpatient physical therapy plan of care.
Modifier GQ
What is modifier GQ? Via asynchronous telecommunications system.
Modifier GR
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.
Modifier GS
What is modifier GS? Dosage of erythropoietin stimulating agent has been reduced and maintained in response to hematocrit or hemoglobin level.
Modifier GT
What is modifier GT? Via interactive audio and video telecommunication systems.
Modifier GU
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.
Modifier GX
What is modifier GX? Notice of liability issued, voluntary under payer policy.
Modifier GY
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.
Modifier GZ
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..
Modifier H9
What is modifier H9? Court-ordered.
Modifier HA
What is modifier HA? Child/adolescent program.
Modifier HB
What is modifier HB? Adult program, non geriatric.
Modifier HC
What is modifier HC? Adult program, geriatric.
Modifier HD
What is modifier HD? Pregnant/parenting women’s program.
Modifier HE
What is modifier HE? Mental health program.
Modifier HF
What is modifier HF? Substance abuse program.
Modifier HG
What is modifier HG? Opioid addiction treatment program.
Modifier HH
What is modifier HH? Integrated mental health/substance abuse program.
Modifier HI
What is modifier HI? Integrated mental health and intellectual disability/developmental disabilities program.
Modifier HJ
What is modifier HJ? Employee assistance program.
Modifier HK
What is modifier HK? Specialized mental health programs for high-risk populations.
Modifier HL
What is modifier HL? Intern.
Modifier HM
What is modifier HM? Less than bachelor’s degree level.
Modifier HN
What is modifier HN? Bachelor’s degree level.
Modifier HO
What is modifier HO? Master’s degree level.
Modifier HP
What is modifier HP? Doctoral level.
Modifier HQ
What is modifier HQ? Group setting (for behavioral health use).
Modifier HR
What is modifier HR? Family/couple with the client present.
Modifier HS
What is modifier HS? Family/couple without the client present.
Modifier HT
What is modifier HT? Multidisciplinary team (for behavioral health use).
Modifier HU
What is modifier HU? Funded by a child welfare agency.
Modifier HV
What is modifier HV? Funded state addictions agency.
Modifier HW
What is modifier HW? Funded by state mental health agency.
Modifier HX
What is modifier HX? Funded by county/local agency.
Modifier HY
What is modifier HY? Funded by juvenile justice agency.
Modifier HZ
What is modifier HZ? Funded by criminal justice agency.
Modifier J1
What is modifier J1? Competitive acquisition program no-pay submission for a prescription number.
Modifier J2
What is modifier J2? Competitive acquisition program, restocking of emergency drugs after emergency administration.
Modifier J3
What is modifier J3? Competitive acquisition program (CAP), drug not available through cap as written, reimbursed under average sales price methodology.
Modifier J4
What is modifier J4? DMEPOS item subject to DMEPOS competitive bidding program that is furnished by a hospital upon discharge.
Modifier J5
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.
Modifier JA
What is modifier JA? Administered intravenously.
Modifier JB
What is modifier JB? Administered subcutaneously.
Modifier JC
What is modifier JC? Skin substitute used as a graft.
Modifier JD
What is modifier JD? Skin substitute is not used as a graft.
Modifier JE
What is modifier JE? Administered via dialysate.
Modifier JG
What is modifier JG? Drug or biological acquired with 340b drug pricing program discount.
Modifier JW
What is modifier JW? Drug amount discarded/not administered to any patient.
Modifier K0
What is modifier K0? Lower extremity prosthesis functional level 0.
Modifier K1
What is modifier K1? Lower extremity prosthesis functional level 1.
Modifier K2
What is modifier K2? Lower extremity prosthesis functional level 2.
Modifier K3
What is modifier K3? Lower extremity prosthesis functional level 3.
Modifier K4
What is modifier K4? Lower extremity prosthesis functional level 4.
Modifier KA
What is modifier KA? Add on option/accessory for a wheelchair.
Modifier KB
What is modifier KB? The beneficiary requested an upgrade for ABN. More than four modifiers identified on the claim
Modifier KC
What is modifier KC? Replacement of special power wheelchair interface.
Modifier KD
What is modifier KD? Drug or Biological infused through implanted DME.
Modifier KE
What is modifier KE? Bid under round one of the DMEPOS competitive bidding program for use with non-competitive bid base equipment.
Modifier KF
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..
Modifier KG
What is modifier KG? DMEPOS item subject to DMEPOS competitive bidding program number 1.
Modifier KH
What is modifier KH? DMEPOS item. Initial claim. Purchase or first month rental.
Modifier KI
What is modifier KI? DMEPOS item. Second or third month rental.
Modifier KJ
What is modifier KJ? DMEPOS item. Parenteral enteral nutrition (PEN) pump or capped rental. Months 4 to 15.
Modifier KK
What is modifier KK? DMEPOS item subject to DMEPOS competitive bidding program number 2.
Modifier KL
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..
Modifier KM
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..
Modifier KN
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..
Modifier KO
What is modifier KO? Single drug unit dose formulation.
Modifier KP
What is modifier KP? The first drug of a multiple drug unit dose formulation.
Modifier KQ
What is modifier KQ? Second or subsequent drug of a multiple drug unit dose formulation.
Modifier KR
What Is A KR Modifier? Rental item, billing for partial month.
Modifier KS
What is modifier KS? Glucose monitor supply for a diabetic beneficiary not treated with insulin.
Modifier KT
What is modifier KT? Beneficiary resides in a competitive bidding area and travels outside that competitive bidding area and receives a competitive bid item.
Modifier KU
What is modifier KU? DMEPOS item subject to DMEPOS competitive bidding program number 3.
Modifier KV
What is modifier KV? DMEPOS item subject to DMEPOS competitive bidding program that is furnished as part of a professional service.
Modifier KW
What is modifier KW? DMEPOS item subject to DMEPOS competitive bidding program number 4.
Modifier KX
What is modifier KX? Requirements specified in the medical policy have been met.
program number 4.
Modifier KY
What is modifier KY? DMEPOS item subject to DMEPOS competitive bidding program number 5.
Modifier KZ
What is modifier KZ? New coverage not implemented by managed care.
Modifier LC
What is modifier LC? Left anterior descending coronary artery.
Modifier LD
What is modifier LD? Left anterior descending coronary artery.
Modifier LL
What is modifier LL? Lease/rental. Use this modifier when DME equipment rental is to be applied against the purchase price.
Modifier LM
What is modifier LM? Left main coronary artery.
Modifier LR
What is modifier LR? Laboratory round trip.
Modifier LS
What is modifier LS? FDA-monitored intraocular lens implant.
Modifier LT
What is modifier LT? Left side. This modifier is used to identify procedures performed on the left side of the body.
Modifier M2
What is modifier M2? Medicare secondary payer (MSP).
Modifier MA
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.
Modifier MB
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.
Modifier MC
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.
Modifier MD
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.
Modifier ME
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.
Modifier MF
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.
Modifier MG
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.
Modifier MH
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.
Modifier MS
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.
Modifier NB
What is modifier NB? Nebulizer system. Any type. FDA-cleared for use with a specific drug.
Modifier NR
What is modifier NR? New when rented. Use modifier NR when new DME at the rental time is subsequently purchased.
Modifier NU
What is modifier NU? New equipment (DME).
Modifier P1
What is modifier P1? A normal healthy patient.
Modifier P2
What is modifier P2? A patient with mild systemic disease.
Modifier P3
What is modifier P3? A patient with severe systemic disease.
Modifier P4
What is modifier P4? A patient with a severe systemic disease that is a constant threat to life.
Modifier P5
What is modifier P5? A moribund patient is not expected to survive without the operation.
Modifier P6
What is modifier P6? A declared brain-dead patient whose organs are being removed for donor purposes.
Modifier PA
What is modifier PA? Surgical or other invasive procedure on the wrong body part.
Modifier PB
What is modifier PB? Surgical or other invasive procedure on the wrong patient.
Modifier PC
What is modifier PC? Wrong surgery or other invasive procedure on a patient.
Modifier PD
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.
Modifier PI
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.
Modifier PL
What is modifier PL? Progressive addition lenses.
Modifier PM
What is modifier PM? Post mortem.
Modifier PN
What is modifier PN? Non-excepted service is provided at an off-campus, outpatient, provider-based hospital department.
Modifier PO
What is modifier PO? Excepted service provided at a hospital’s off-campus, outpatient, provider-based department.
Modifier PS
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.
Modifier PT
What is modifier PT? Colorectal cancer screening test; converted to diagnostic test or other procedure.
Modifier Q0
What is modifier Q0? An investigational clinical service that is provided in a clinical research study that is in an approved clinical research study.
Modifier Q1
What is modifier Q1? A routine clinical service that is provided in a clinical research study that is in an approved clinical research study.
Modifier Q2
What is modifier Q2? Demonstration procedure or service.
Modifier Q3
What is modifier Q3? Live kidney donor surgery and related services.
Modifier Q4
What is modifier Q4? Service for ordering/referring physician qualifies as a service exemption.
Modifier Q5
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.
Modifier Q6
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.
Modifier Q7
What is modifier Q7? One class A finding.
Modifier Q8
What is modifier Q8? Two class B findings.
Modifier Q9
What is modifier Q9? One class B and two class C findings.
Modifier QA
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).
Modifier QB
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.
Modifier QC
What is modifier QC? Single channel monitoring.
Modifier QD
What is modifier QD? Recording and storage in solid state memory by a digital recorder.
Modifier QE
What is modifier QE? The prescribed amount of stationary oxygen at rest is less than one liter per minute (LPM).
Modifier QF
What is modifier QF? The prescribed amount of stationary oxygen at rest exceeds four liters per minute (LPM), and portable oxygen is prescribed.
Modifier QG
What is modifier QG? The prescribed amount of stationary oxygen at rest is greater than 4 Liters per minute (LPM).
Modifier QH
What is modifier QH? An oxygen conserving device is being used with an oxygen delivery system.
Modifier QJ
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).
Modifier QK
What is modifier QK? The medical direction of two, three, or four concurrent anesthesia procedures involves qualified individuals.
Modifier QL
What is modifier QL? The patient was pronounced dead after an ambulance was called.
Modifier QM
What is modifier QL? An ambulance service is provided under an arrangement by a provider of services.
Modifier QN
What is modifier QN? An ambulance service is furnished directly by a provider of services.
Modifier QP
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.
Modifier QQ
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..
Modifier QR
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)
Modifier QS
What is modifier QS? Monitored anesthesia care services.
Modifier QT
What is modifier QT? Recording and storage on tape by an analog tape recorder.
Modifier QW
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).
Modifier QX
What is modifier QX? CRNA service with medical direction by a physician.
Modifier QY
What is modifier QY? Medical direction of one certified registered nurse anesthetist (CRNA) by an anesthesiologist
Modifier QZ
What is modifier QZ? CRNA service without medical direction by a Physician.
Modifier RA
What is modifier RA? Replacement of a DME, prosthetic or orthotic item.
Modifier RB
What is modifier RB? Replacement of a part of a DME, prosthetic or orthotic item furnished as part of a repair.
Modifier RC
What is modifier RC? Right coronary artery.
Modifier RD
What is modifier RD? Drug provided to the beneficiary. Not administered ‘incident-to’.
Modifier RE
What is modifier RE? Furnished in full compliance with a fda-mandated risk evaluation and mitigation strategy (REMS).
Modifier RI
What is modifier RI? Ramus intermedius coronary artery.
Modifier RR
What is modifier RR? Rental. Use modifier RR when DME is to be rented.
Modifier RT
What is modifier RT? Right Side. The RT modifier is used to identify procedures performed on the right side of the body.
Modifier SA
What is modifier SA? A nurse practitioner renders service in collaboration with a Physician.
Modifier SB
What is modifier SB? Nurse midwife.
Modifier SC
What is modifier SC? Medically necessary service or supply.
Modifier SD
What is modifier SD? Services provided by registered nurse with specialized, highly technical home infusion training.
Modifier SE
What is modifier SE? State and/or federally-funded programs/services.
Modifier SF
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).
Modifier SG
What is modifier SG? Ambulatory surgical center (ASC) facility service.
Modifier SH
What is modifier SH? A second concurrently administered infusion therapy.
Modifier SJ
What is modifier SJ? A third or more concurrently administered infusion therapy.
Modifier SK
What is modifier SK? Member of a high-risk population. Use modifier SK only with codes for immunization).
Modifier SL
What is modifier SL? State supplied vaccine.
Modifier SM
What is modifier SM? A 2nd surgical opinion.
Modifier SN
What is modifier SN? A 3rd surgical opinion.
Modifier SQ
What is modifier SQ? An item ordered by home health.
Modifier SS
What is modifier SS? The home infusion services are provided in the infusion suite of the iv therapy provider.
Modifier ST
What is modifier ST? Related to trauma or injury.
Modifier SU
What is modifier SU? Procedure performed in physician’s office. Use this modifier to denote the use of facility and equipment.
Modifier SV
What is modifier SV? Pharmaceuticals delivered to patient’s home but not utilized.
Modifier SW
What is modifier SW? The services are provided by a certified diabetic educator.
Modifier SY
What is modifier SY? Persons who are in close contact with members of high-risk populations. Use modifier SY only with codes for immunization.
Modifier T1
What is modifier T1? Left foot. The 2nd digit.
Modifier T2
What is modifier T2? Left foot. The 3rd digit
Modifier T3
What is modifier T3? Left foot. The 4th digit.
Modifier T4
What is modifier T4? Left foot. The 5th digit.
Modifier T5
What is modifier T5? Right foot. The great toe.
Modifier T6
What is modifier T6? Right foot. The 2nd digit.
Modifier T7
What is modifier T7? Right foot. The 3rd digit.
Modifier T8
What is modifier T8? Right foot. The 4th digit.
Modifier T9
What is modifier T9? Right foot. The 5th digit.
Modifier TA
What is modifier TA? Left foot. The great toe.
Modifier TB
What is modifier TB? Drug or biological acquired with 340b drug pricing program discount. This modifier is used for informational purposes.
Modifier TC
What is modifier TC? Technical component only. Use modifier TC to indicate the technical part of a diagnostic procedure performed.
Modifier TD
What is modifier TD? Registered Nurse (RN). USe this modifier for behavioral health use.
Modifier TE
What is modifier TE? Licensed Practical Nurse (LPN). Use this modifier for behavioral health use.
Modifier TF
What is modifier TF? Intermediate level of care.
Modifier TG
What is modifier TG? Complex and/or high-tech level of care.
Modifier TH
What is modifier TH? Obstetrical treatment and/or services. Postpartum or prenatal.
Modifier TJ
What Is A TJ Modifier? Program group. Adolescents and/or children. Use this modifier for enhancement payment for foster care children screening exams.
Modifier TK
What Is A TK Modifier? Extra member or passenger. Non-ambulance transportation.
Modifier TL
What is modifier TL? Early intervention/individualized family service plan (IFSP).
Modifier TM
What is modifier TM? Individualized education program (IEP).
Modifier TN
What is modifier TN? Rural/outside providers’ customary service area.
Modifier TP
What is modifier TP? Medical transport. Unloaded vehicle.
Modifier TQ
What is modifier TQ? Basic life support transport by a volunteer ambulance provider.
Modifier TR
What is modifier TR? School-based individualized education program (IEP) services provided outside the public school district responsible for a student.
Modifier TS
What is modifier TS? Follow-up service.
Modifier TT
What is modifier TT? Individualized service is provided to more than one patient in the same setting.
Modifier TU
What is modifier TU? Special payment rate for overtime.
Modifier TV
What is modifier TV? Special payment rates for holidays or weekends.
Modifier TW
What is modifier TW? Back-up equipment.
Modifier U1
What is modifier U1? Medicaid level of care one. The level is defined by each state.
Modifier U2
What is modifier U2? Medicaid level of care two. The level is defined by each state..
Modifier U3
What is modifier U3? Medicaid level of care three. The level is defined by each state.
Modifier U4
What is modifier U4? Medicaid level of care four. The level is defined by each state.
Modifier U5
What is modifier U5? Medicaid level of care five. The level is defined by each state.
Modifier U6
What is modifier U6? Medicaid level of care six. The level is defined by each state.
Modifier U7
What is modifier U7? Medicaid level of care seven. The level is defined by each state.
Modifier U8
What is modifier U8? Medicaid level of care eight. The level is defined by each state.
Modifier U9
What is modifier U9? Medicaid level of care nine. The level is defined by each state.
Modifier UA
What is modifier UA? Medicaid level of care ten. The level is defined by each state.
Modifier UB
What is modifier UB? Medicaid level of care eleven. The level is defined by each state.
Modifier UC
What is modifier UC? Medicaid level of care twelve. The level is defined by each state.
Modifier UD
What is modifier UD? Medicaid level of care thirteen. The level is defined by each state.
Modifier UE
What is modifier UE? Used durable medical equipment.
Modifier UF
What is modifier UF? Services provided in the morning.
Modifier UG
What is modifier UG? Services provided in the afternoon.
Modifier UH
What is modifier UH? Services provided in the evening.
Modifier UJ
What is modifier UJ? Services provided at night.
Modifier UK
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.
Modifier UN
What is modifier UN? Two patients for portable X-rays.
Modifier UP
What is modifier UP? Three patients for portable X-rays.
Modifier UQ
What is modifier UQ? Four patients for portable X-rays.
Modifier UR
What is modifier UR? Five patients for portable X-rays.
Modifier US
What is modifier US? Six or more patients for portable X-rays.
Modifier V1
What is modifier V1? Demonstration modifier one.
Modifier V2
What is modifier V2? Demonstration modifier two.
Modifier V3
What is modifier V3? Demonstration modifier three.
Modifier V4
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.
Modifier VM
What is modifier VM? Medicare diabetes prevention program (MDPP) virtual make-up session.
Modifier VP
What is modifier VP? Aphakic patient.
Modifier X1
What is modifier X1? Continuous or broad services.
Modifier X2
What is modifier X2? Continuous or focused services.
Modifier X3
What is modifier X3? Episodic or broad services.
Modifier X4
What is modifier X4? Episodic or focused services.
Modifier X5
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.
Are you looking for the CPT modifier list? You can find it here.
This content may be outdated
This article was published more than 1 year ago. While we strive to keep our content up to date, medical coding guidelines and regulations may have changed since then.
