Modifier – as the name implies a modifier will modify a service / procedure or an item under certain circumstances for appropriate reimbursement. Modifiers may add information or change the description according to the physician documentation to give more specificity for the service or procedure rendered. Appending of an appropriate modifier will effectively respond to reimbursement.
Modifiers are two digit codes and are categorized into two levels:
- Level I CPT Modifiers: Normally known as CPT Modifiers and consists of two numeric digits and are updated annually by AMA – American Medical Association.
- Level II HCPCS Modifiers: Normally known as HCPCS Modifiers and consists of two digits (Alpha / Alphanumeric characters) in the sequence AA through VP. These modifiers are annually updated by CMS – Centres for Medicare and Medicaid Services.
Both the above levels of Modifiers are recognized nationally.
Level I CPT Modifiers
CPT Modifier 21
What Is A CPT 21 Modifier? Prolonged Evaluation and Management Services (Deleted, please use CPT 99354- CPT 99359).
Usage and Reimbursement CPT Modifier 21: CPT Modifier 21 is used when the face-to-face service provided is prolonged or otherwise greater than usually required for the highest level of evaluation and management (E&M) service within a.. Read more..
CPT Modifier 22
What Is A CPT 22 Modifier?: Increased Procedural Services.
Usage and Reimbursement of CPT Modifier 22: As the description implies this modifier should not be reported with an Evaluation and Management services. It should only be reported with procedure codes that have a global period of , 10, 90 days.. Read more..
CPT Modifier 23
What Is A 23 Modifier?: Unusual Anesthesia.
Usage and Reimbursement of CPT Modifier 23: Occasionally, a procedure, which usually requires either no anesthesia or local anesthesia, because of unusual circumstances must be done under general anesthesia. This is considered.. Read more..
CPT Modifier 24
What Is A 24 Modifier? Unrelated Evaluation and Management Service by the Same Physician during a Postoperative Period.
Usage and Reimbursement of CPT Modifier 24: Append CPT Modifier 24 to the E/M procedure code or eye exam. Use on an unrelated E/M service beginning the day after a procedure, when the E/M is performed by the same physician during.. Read more..
CPT Modifier 25
What Is A 25 Modifier?: Significant, Separately Identifiable Evaluation and Management Service by the Same Physician on the Same Day of the Procedure or Other Service.
Usage and Reimbursement of CPT Modifier 25: Physicians and Qualified Nonphysician practitioners (NPP) should use CPT Modifier 25 to designate a significant, separately identifiable E/M service provided by the same physician/qualified.. Read more..
CPT Modifier 26
What Is A 26 Modifier?: Professional Component.
Usage and Reimbursement of CPT Modifier 26: CPT Modifier 26 identifies the physician’s or professional component of a two-component (professional and technical) service. The physician component is reported separately when the.. Read more..
CPT Modifier 27
What Is A 27 Modifier?: Multiple Outpatient Hospital E/M Encounters on the Same Date.
Usage and Reimbursement of CPT Modifier 27: The CPT defines Modifier 27 as “multiple outpatient hospital evaluation and management encounters on the same date.” Use this modifier when a patient receives multiple E/M services performed.. Read more..
CPT Modifier 29
What Is A 29 Modifier?: Global procedures, those procedures where one provider is responsible for both the professional and technical component.
Note: This modifier has been deleted. If a provider is billing for a global service, no modifier is necessary.
CPT Modifier 32
What Is A 32 Modifier?: Mandated Services.
Usage and Reimbursement of CPT Modifier 32: CPT Modifier 32 should be used when services related to mandated consultation and / or related services such as confirmatory consultations and related diagnostic service (eg. third.. Read more..
CPT Modifier 33
What Is A 33 Modifier?: Preventive Service.
Usage and Reimbursement of CPT Modifier 33: When the primary purpose of the service is the delivery of an evidence-based service in accordance with a US Preventive Services Task Force A or B rating in effect and other preventive.. Read more..
CPT Modifier 47
What Is A 47 Modifier? Anesthesia by Surgeon.
Usage and Reimbursement of CPT Modifier 47: CPT Modifier 47 is used to report regional or CPT code for general anesthesia provided by the attending or assistant surgeon. Add CPT Modifier 47 to the basic service. This does not include.. Read more..
CPT Modifier 50
What Is A 50 Modifier? Bilateral Procedure.
Usage and Reimbursement of CPT Modifier 50: Bilateral services are procedures performed on both sides of the body during the same operative session or on the same day. CPT Modifier 50 is not applicable to procedures.. Read more..
CPT Modifier 51
What Is A 51 Modifier?: Multiple Procedures.
Usage and Reimbursement of CPT Modifier 51: CPT Modifier 51 designates multiple procedures that are rendered at the same operative session or on the same day. CPT Modifier 51 (multiple procedures) must be used to indicate instances when.. Read more..
CPT Modifier 52
What Is A 52 Modifier?: Reduced Services.
Usage and Reimbursement of CPT Modifier 52: CPT Modifier 52 identifies situations where the physician elects to reduce or eliminate a portion of a service or procedure. Cover letters or operative reports are not necessary when CPT Modifier 52 is.. Read more..
CPT Modifier 53
What Is A 53 Modifier?: Discontinued Procedure.
Usage and Reimbursement of CPT Modifier 53: Under certain circumstances, the physician may elect to terminate a surgical or diagnostic procedure due to extenuating circumstances or those that threaten the well being of the.. Read more..
CPT Modifier 54
What Is A 54 Modifier?: Surgical Care Only.
Usage and Reimbursement of CPT Modifier 54:
CPT Modifier 54 identifies when one physician performs a surgical procedure and another provides preoperative and/or postoperative management. The surgeon who performs the surgical procedure reports CPT Modifier 54. Submit CPT Modifier 54 only with.. Read more..
CPT Modifier 55
What Is A 55 Modifier?: Postoperative Management Only.
Usage and Reimbursement of CPT Modifier 55: When one physician performed the postoperative management only modifier and another physician performed the surgical procedure, the postoperative component may be identified by adding CPT Modifier 55.. Read More..
CPT Modifier 56
What Is A 56 Modifier?: Preoperative Management Only.
Usage and Reimbursement of CPT Modifier 56: When one physician performed the preoperative care and evaluation and another physician performed the surgical procedure, the preoperative component may be identified by adding CPT Modifier 56 to.. Read more..
CPT Modifier 57
What Is A 57 Modifier?: Decision for Surgery.
Usage and Reimbursement of CPT Modifier 57: CPT Modifier 57 is used when the initial decision to perform a major surgical procedure is made during an E&M service provided the day before or the day of a major surgery. CPT Modifier 57 replaces HCPCS Level II Modifier QI.. Read more..
CPT Modifier 58
What Is A 58 Modifier?: Staged or Related Procedure or Service by the Same Physician During the Postoperative Period.
Usage and Reimbursement of CPT Modifier 58: The Modifier 58 definition is explained as the CPT Manual as a “staged or related procedure or service by the same physician during the postoperative period”. It may be used to indicate that a procedure.. Read more..
CPT Modifier 59
What Is A 59 Modifier?: Distinct Procedural Service.
Usage and Reimbursement of CPT Modifier 59: Modifier 59 is used to indicate a distinct procedural service. The physician may need to indicate that a procedure or service was distinct or independent from other services performed on the same day. This may.. Read more..
CPT Modifier 62
What Is A 62 Modifier?: Two Surgeons.
CPT Modifier 63
What Is A 63 Modifier?: Procedure Performed on Infants less than 4kg.
CPT Modifier 66
What Is A 66 Modifier?: Surgical Team.
CPT Modifier 73
What Is A 73 Modifier?: Discontinued Outpatient Hospital/Ambulatory Surgery Center (ASC) Procedure prior to the Administration of Anesthesia.
CPT Modifier 74
What Is A 74 Modifier?: Discontinued Outpatient Hospital/Ambulatory Surgery Center (ASC) Procedure after Administration of Anesthesia.
CPT Modifier 76
What Is A 76 Modifier?: Repeat Procedure by Same Physician.
CPT Modifier 77
What Is A 77 Modifier?: Repeat Procedure by Another Physician.
CPT Modifier 78
What Is A 78 Modifier?: Return to the Operating Room for a Related Procedure During the Postoperative Period.
CPT Modifier 79
What Is A 79 Modifier?: Unrelated Procedure or Service by the Same Physician During the Postoperative Period.
CPT Modifier 80
What Is An 80 Modifier? Assistant Surgeon.
CPT Modifier 81
What Is An 81 Modifier?: Minimum Assistant Surgeon.
CPT Modifier 82
What Is An 82 Modifier?: Assistant Surgeon (when qualified resident surgeon not available).
CPT Modifier 90
What Is A 90 Modifier? Reference (Outside) Laboratory.
CPT Modifier 91
What Is A 91 Modifier? Repeat Clinical Diagnostic Laboratory Test.
CPT Modifier 92
What Is A 92 Modifier?: Alternative Laboratory Platform Testing.
CPT Modifier 96
What Is A 96 Modifier?: Habilitative Services.
Usage and Reimbursement of CPT Modifier 96: When a service or procedure that may either be habilitative in nature or rehabilitative in nature is provided for habilitative purposes, the physician or other qualified healthcare professional may add CPT Modifier 96 to.. Read more..
CPT Modifier 97
What Is A 97 Modifier?: Rehabilitative Services.
Usage and Reimbursement of CPT Modifier 97: When a service or procedure that may be either habilitative or rehabilitative in nature is provided for rehabilitative purposes, the physician or other qualified healthcare professional may add CPT Mmodifier 97.. Read more..
CPT Modifier 99
What Is A 99 Modifier?: Multiple Modifiers.
HCPCS Level II Modifiers
What Is An AA Modifier?: Anesthesia services personally performed by anesthesiologist.
What Is An AD Modifier?: Medical supervision by a physician: More than 4 concurrent anesthesia procedures.
What Is AN AE Modifier?: Registered Dietician.
What Is An AF Modifier?: Specialty Physician.
What Is An AG Modifier?: Primary Physician.
What Is An AH Modifier?: Clinical Psychologist.
What Is An AI 79 Modifier?: Principal Physician of Record.
What Is An AJ Modifier?: Clinical Social Worker.
What Is An AK Modifier?: Non Participating Physician.
What Is An AM Modifier?: Physician, team member service.
What Is An AP Modifier?: Determination of refractive state was not performed in the course of diagnostic ophthalmological examination.
What Is An AQ Modifier?: Service performed in a Health Professional Shortage Area.
What Is An AR Modifier? Physician providing services in a physician scarcity area.
What Is An AS Modifier?: Physician Assistant, Nurse Practitioner, or Clinical Nurse Specialist services for assistant-at-surgery, non-team member.
What Is An AT Modifier?: Acute treatment (chiropractic claims).
Note: This modifier should be used when reporting CPT 98940, CPT 98941, CPT 98942 or CPT 98943 for acute treatment.
What Is An AU Modifier?: Item furnished in conjunction with a urological, ostomy, or tracheostomy supply.
Usage of Modifier AU: Modifier AU is only applicable for the HCPCS codes: A4217 (Sterile water/saline, 500 ml), A4450 (Tape, nonwaterproof, per 18.. Read more..
What Is An AV Modifier?: Item furnished in conjunction with a prosthetic device, prosthetic or orthotic.
Usage of Modifier AU: Modifier AU is only applicable for the HCPCS codes; A4450 (Tape, nonwaterproof, per 18 sq in), A4452 (Tape, waterproof, per 18.. Read more..
What Is An AW Modifier?: Item furnished in conjunction with a surgical dressing.
Usage of Modifier AW: Modifier AW is only applicable for the HCPCS codes; A4450 (Tape, nonwaterproof, per 18 sq in), A4452 Tape, waterproof, per 18.. Read more..
What Is An AX Modifier?: Item furnished in conjunction with dialysis services.
What Is An AY Modifier?: Item or service furnished to an ESRD patient that is not for the treatment of ERSD.
Description of Modifier AZ:Physician providing a service in a dental Health Professional Shortage Area for the purpose of an Electronic Health Record Incentive Payment.
What Is An A1 Modifier?: Dressing for one wound.
What Is An A2 79 Modifier?: Dressing for two wounds.
What Is An A3 Modifier?: Dressing for three wounds.
What Is An A4 Modifier?: Dressing for four wounds.
What Is An A5 Modifier?: Dressing for five wounds.
What Is An A6 Modifier?: Dressing for six wounds.
What Is An A7 Modifier?: Dressing for seven wounds.
What Is An A8 Modifier? : Dressing for eight wounds.
What Is n A9 Modifier?: Dressing for nine or more wounds.
What Is A BA Modifier?: Item furnished in conjunction with parenteral enteral nutrition (PEN) services.
What Is A BL Modifier?: Special Acquisition of blood and blood products.
What Is A CA Modifier? Procedure payable only in the inpatient setting when performed emergently on an outpatient who expires prior to admission.
What Is A CB Modifier?: Services ordered by a dialysis facility physician as part of the ESRD beneficiary’s dialysis benefit.
What Is A CC Modifier?: Procedure code change- CARRIER USE ONLY – Used by carrier to indicate that the procedure code submitted was changed either for administrative reasons or because an incorrect code was filed.
Automated Multi-Channel Chemistry (AMCC) Tests Modifiers
What Is A CD Modifier? :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 A CE Modifier?: AMCC tests has been ordered by an ESRD facility or MCP physician that is a composite rate test but is beyond the normal frequency covered under the rate and is separately reimbursable based on medical necessity.
What Is A CF Modifier?: AMCC tests has been ordered by an ESRD facility or MCP physician that is not part of the composite rate and is separately billable.
Modifiers Used to Report the Severity of Functional Limitations
What Is A CH Modifier?: 0 percent impaired, limited or.. Read more..
What Is A CI Modifier?: At least 1 percent but less than.. Read more..
What Is A CJ Modifier? At least 20 percent but less than.. Read more..
What Is A CK Modifier?: At least 40 percent but less.. Read more..
What Is A CL Modifier?: At least 60 percent but less.. Read more..
What Is A CM Modifier?: At least 80 percent but less than.. Read more..
What Is A CN Modifier?: 100 percent impaired, limited or.. Read more..
What Is A CM Modifier?: Catastrophe/Disaster Related.
What Is A CS Modifier?: Item or service related, in whole or in part, to an illness, injury, or condition that was caused by or exacerbated by the effects, direct or indirect, of the 2010 oil spill in the Gulf of Mexico, including but not limited to subsequent clean-up activities.
What Is A DA Modifier?: Oral health assessment by a licensed Health Professional other than a dentist.
What Is An EA Modifier?: Erythropetic stimulating agent (ESA) administered to treat anemia due to anti-cancer chemotherapy.
Usage and Reimbursement of Modifier EA: The EA modifier should only be reported when the ESA is being given for anemia resulting from myelosuppressive anticancer chemotherapy in solid tumors, multiple myeloma, lymphoma, and.. Read more..
What Is An EB Modifier?: Erythropetic stimulating agent (ESA) administered to treat anemia due to anti-cancer radiotherapy.
Usage and Reimbursement of Modifier EB: CMS EB uses this modifier 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 An EC Modifier?: Erythropetic stimulating agent (ESA) administered to treat anemia not due to anti-cancer radiotherapy or anti-cancer chemotherapy.
Usage and Reimbursement of Modifier EC: 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 An ED Modifier?: Hematocrit level has exceeded 39% (or Hemoglobin level has exceeded 13.0 G/DL) for 3 or more consecutive billing cycles immediately prior to and including the current cycle.
What Is An EE Modifier?: Hematocrit level has not exceeded 39% (or Hemoglobin level has not exceeded 13.0 G/DL) for 3 or more consecutive billing cycles immediately prior to and including the current cycle.
What Is An E1 Modifier?: Upper left, eyelid.
What Is An E2 Modifier?: Lower left, eyelid.
What Is An E3 Modifier? Upper right, eyelid.
What Is An E4 Modifier?Lower right, eyelid.
What Is An EJ Modifier? Subsequent claims for a defined course of therapy, e.g., EPO, sodium hyaluronate, infliximab.
What Is An EM Modifier? Emergency reserve supply (for ESRD benefit only).
What Is An ET Modifier? Emergency treatment – Use to designate a dental procedure performed in an emergency situation.
What Is A FA Modifier? Left hand, thumb.
What Is A F1 Modifier? Left hand, second digit.
What Is A F2 Modifier? Left hand, third digit.
What Is A F3 Modifier? Left hand, fourth digit.
What Is A F4 Modifier? Left hand, fifth digit.
What Is A F5 Modifier? Right hand, thumb.
What Is A F6 Modifier? Right hand, second digit.
What Is A F7 Modifier? Right hand, third digit.
What Is A F8 Modifier? Right hand, fourth digit.
What Is A F9 Modifier? Right hand, fifth digit.
What Is A FB Modifier? Item provided without cost to provider, supplier or practitioner, or credit received for replaced device (examples, but not limited to covered under warranty, replaced due to defect, free samples)
What Is A FC Modifier? Partial credit received for replaced device
What Is A FY Modifier? Designates imaging services that are X-rays taken using computed radiography.
Usage of Modifier FY: Beginning January 1, 2018, and including Calendar Years (CY) 2018-CY 2022, a payment reduction of 7 percent applies to the technical component (and the technical component of the global fee) for computed radiography services.. Read more..
What Is A G1 Modifier? Most recent URR of less than.. Read more..
What Is A G2 Modifier? Most recent URR of 60% to.. Read more..
What Is A G3 Modifier? Most recent URR of 65% to.. Read more..
What Is A G4 Modifier? Most recent URR of 70% to.. Read more..
What Is A G5 Modifier? Most recent URR of 75% or.. Read more..
What Is A G6 Modifier? ESRD patient for whom less than seven dialysis sessions have been.. Read more..
What Is A G7 Modifier? Pregnancy resulted from rape or incest or pregnancy certified by physician as life threatening
What Is A GA Modifier? Waiver of liability statement on file – Use to indicate that the physician’s office has a signed advance notice retained in the patient’s medical record.The notice is for services that may be denied by Medicare.
Usage of Modifier GA: Modifier GA must be used when physicians, practitioners, or suppliers want to indicate that they expect that Medicare will deny a service as not reasonable and necessary, and they do have an ABN signed by the.. Read more..
What Is A GC Modifier? This service has been performed in part by a resident under the direction of a teaching physician.
Description of Modifier GD: Units of service exceeds medically unlikely edit value and represents reasonable and necessary services.
What Is A GE Modifier? This service has been performed by a resident without the presence of a teaching physician under the primary care exception.
What Is A GF Modifier? Physician services provided by a nonphysician in a critical access hospital; nonphysician: NP, Certified Registered Nurse Anesthetist (CRNA), Certified Registered Nurse (CRN), CNS or PA.
What Is A GG Modifier? Diagnostic Mammography – Use to indicated performance and payment of a screening mammography and diagnostic mammography on same patient, on the same day.
What Is A GH Modifier? Diagnostic mammogram converted from screening mammogram on same day.
What Is A GJ Modifier? Opted Out physician or practitioner – Use to indicate services performed in an emergency or urgent service.
Usage of Modifier GJ: In an emergency or urgent care situation, a provider may treat a Medicare beneficiary with whom he or she does not have a private contract and bill Medicare for such treatment. The provider may not charge the beneficiary more than.. Read more..
What Is A GM Modifier? Multiple patients on one ambulance trip.
What Is A GN Modifier? Services delivered under an outpatient speech language pathology plan of care.
What Is A GO Modifier? Services delivered under an outpatient occupational therapy plan of care.
What Is A GP Modifier? Services delivered under an outpatient physical therapy plan of care.
What Is A GQ Modifier? Telehealth services via asynchronous telecommunications system.
What Is A GR Modifier? 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 A GS Modifier? Dosage of EPO or Darbepoietin Alfa has been reduced and maintained in response to hematocrit or hemoglobin level.
What Is A GT Modifier?: Telehealth services via interactive audio and video telecommunication systems.
What Is A GU Modifier? Waiver of liability statement issued as required by a payer policy, routine notice.
What Is A GW Modifier? Service not related to the hospice patient’s terminal condition.
What Is A GV Modifier? Attending physician not employed or paid under agreement by the patient’s hospice provider.
What Is A GY Modifier? Use to indicate when an item or service statutorily excluded or does not meet the definition of any Medicare benefit.
What Is A GZ Modifier? Use to indicate when an item or service expected to be denied as not reasonable and necessary.Used when no Advanced Beneficiary Notice (ABN) signed by the beneficiary.
Usage of Modifier GZ: must be used when physicians, practitioners, or suppliers want to indicate that they expect that Medicare will deny an item or service as not reasonable and necessary, and they do not have an ABN modifiers signed.. Read more..
What Is A HM Modifier? Less than Bachelor’s degree level.
What Is A HN Modifier?: Bachelor’s degree level.
What Is A HO Modifier? Master’s degree level,
What Is A HP Modifier?: Doctoral level.
What Is A HQ Modifier? Group setting (for behavioral health use).
What Is A HT Modifier? Multidisciplinary team (for behavioral health use).
Services Funded by a County, State or Federal Agency
What Is A H9 Modifier?: Court-ordered.
What Is A HU Modifier? Funded by child welfare agency.
What Is A HV Modifier? Funded state addictions agency.
What Is A HW Modifier? Funded by state mental health agency.
What Is A HX Modifier?Funded by county/local agency
What Is A HY Modifier? Funded by juvenile justice agency.
What Is A HZ Modifier? Funded by criminal justice agency.
What Is A J1 Modifier? Competitive Acquisition Program, no-pay submission for a prescription number.
What Is A J2 Modifier? Competitive Acquisition Program, restocking of emergency drugs after emergency administration.
What Is A J3 Modifier? Competitive Acquisition Program, (CAP) drug not available through CAP as written, reimburse under ASP Methodology.
What Is A JA Modifier?Administered intravenously.
What Is A JB Modifier?Administered subcutaneoulsly.
What Is A JC Modifier? Skin substitute used as a graft.
What Is A JD Modifier? Skin substitute NOT used as a graft.
What Is A JW Modifier? Drug or biological amount discarded/not administered to any patient.
What Is A KB Modifier? Beneficiary requested upgrade for ABN, more than 4 modifiers identified on claim
What Is A KC Modifier? Replacement of special power wheelchair interface.
What Is A KD Modifier? Drug or Biological infused through implanted DME.
What Is A KE Modifier? Bid under round one of the DMEPOS competitive bidding program for use with non-competitive bid base equipment.
What Is A KF Modifier?Item designated by FDA as Class III device.
Usage of Modifier KF: 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 presence of the KF modifier. KF Modifier is applicable only for.. Read more..
What Is A KL Modifier?: DMEPOS Item Delivered via Mail.
Usage of Modifier KL: Contract suppliers must use the KL Modifier on all claims for diabetic supply codes that are furnished via mail order. Non contract suppliers that furnish mail order diabetic supplies to beneficiaries who do not live in.. Read more..
What Is A KM Modifier?Replacement of facial prosthesis – including new impression/moulage.
Usage of Modifier KM: KM Modifier and KN Modifier are to be used on claims for 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 A KN Modifier? Replacement of facial prosthesis – Using previous master model.
Usage of Modifier KM: KM Modifier and KN Modifier are to be used on claims for 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 A KR Modifier? Rental item, durable medical equipment – billing for partial month.
What Is A KX Modifier? Specific required documentation on file (used for DMERC providers).
What Is A KZ Modifier? New Coverage not implemented by managed care.
What Is A LC Modifier? Left circumflex coronary artery.
What Is A LD Modifier?Left anterior descending coronary artery.
What Is A LM Modifier? Left main coronary artery.
What Is A LR Modifier? Laboratory Round Trip.
What Is A LT Modifier? Left Side – Used to identify procedures performed on the left side of the body.
What Is A M2 Modifier? Medicare Secondary Payer.
What Is A NB Modifier? Nebulizer system, any type, FDA-Cleared fo ruse with specific drug.
What Is A NU Modifier? New equipment (DME).
What Is A P1 Modifier? A normal healthy patient.
What Is A P2 Modifier? A patient with mild systemic disease.
What Is A P3 Modifier? A patient with severe systemic disease.
What Is A P4 Modifier? A patient with severe systemic disease that is a constant threat to life.
What Is A P5 Modifier? A moribund patient who is not expected to survive without the operation.
What Is A P6 Modifier? A declared brain-dead patient whose organs are being removed for donor purposes.
What Is A PA Modifier? Surgery Wrong Body Part.
What Is A PB Modifier? Surgery Wrong Patient.
What Is A PC Modifier? Wrong Surgery on Patient
* Please refer: http://www.cms.hhs.gov/MLNMattersArticles/downloads/MM6718.pdf for proper usage of PA, PB and PC Modifiers
What Is A PD Modifier?: Diagnostic or related non-diagnostic item or service provided in a wholly owned or wholly operated entity to a patient who is admitted as an inpatient within 3 days, or 1 day.
What Is A PI Modifier? PET Tumor init tx strategy.
What Is A PS Modifier? PET Tumor subsq tx strategy.
What Is A PT Modifier? Colorectal cancer screening test; converted to diagnostic test or other procedure.
What Is A PO Modifier? Services, procedures and/or surgeries provided at off-campus provider-based outpatient departments.
What Is A Q0 Modifier? Investigational clinical service provided in a clinical research study that is in an approved clinical research study.
What Is A Q1 Modifier? Routine clinical service provided in a clinical research study that is in an approved clinical research study.
What Is A Q3 Modifier? Liver Kidney Donor Surgery and Related Services.
What Is A Q4 Modifier? Service for ordering/referring physician qualifies as a service exemption –
What Is A Q5 Modifier? Service furnished by a substitute physician under a reciprocal billing arrangement.
DesWhat Is A Q6 Modifier? Service furnished by a locum tenens physician.
What Is A Q7 Modifier? One CLASS A finding.
What Is A Q8 Modifier? Two CLASS B findings.
What Is A Q9 Modifier? One CLASS B and two CLASS C findings.
What Is A QA Modifier? FDA Investigational device exemption (IDE) – The IDE project number must be included on the claim when modifier QA is billed.
What Is A QB Modifier? Physician service in a rural HPSA.
What Is A QC Modifier? Single channel monitoring.
What Is A QD Modifier? Recording and storage in solid state memory by a digital recorder.QJ Services/items provided to a prisoner or patient in state or local custody, however the state or local government, as applicable, meets the requirements in 42 CFR 411.4 (B).
What Is A QK Modifier?: Medical direction of 2, 3 or 4 concurrent anesthesia procedures involving qualified individuals.
What Is A QL Modifier? Patient pronounced dead after ambulance called
What Is A QM Modifier? Ambulance service provided under arrangement by a provider of services
What Is A QN Modifier?Ambulance service furnished directly by a provider of services
QP Panel test – Documentation is on file showing that the laboratory test(s) was ordered individually or ordered as a CPT-recognized panel other than automated profile codes.
What Is A QQ Modifier? Ordering Professional Consulted A Qualified Clinical Decision Support Mechanism For This Service And The Related Data Was Provided To The Furnishing Professional.
Usage of Modifier QQ: Used when the furnishing professional is aware of the result of the ordering professional’s consultation with a CDSM for that patient. Reported on the same claim line as the CPT code for an advanced diagnostic imaging.. Read more..
What Is A QS Modifier? Monitored anesthesia care.
What Is A QT Modifier? Recording and storage on tape by an analog tape recorder.
DWhat Is A QU Modifier? Physician service in an urban HPSA.
What Is A QV Modifier? Item or service provided as routine care in a medical qualifying clinical trial
What Is A QWModifier? CLIA Waived Test – Effective October 1, 1996, all new waived tests are being assigned a CPT code (in lieu of a temporary five-digit G- or Q-code).
What Is A QX Modifier? CRNA service with medical direction by physician.
What Is A QY Modifier? Medical direction of one certified registered nurse anesthetist (CRNA) by an anesthesiologist.
What Is A QZ Modifier? CRNA service without medical direction by a physician.
What Is A RA Modifier?: Replacement of a DME item, Orthotic or Prosthetic Item
What Is A RB Modifier? Replacement of a Part of DME, Orthotic or Prosthetic Item furnished as Part of a Repair
What Is A RC Modifier?Right coronary artery
Modifier RD: Drug provided to beneficiary, but not, administrated incident-to
What Is A RE Modifier? Furnished in full compliance with FDA-Mandated Risk Evaluation and Mitigation Strategy (REMS)
What Is A RI Modifier? Ramus intermedius (Effective for the year 2013)
What Is A RP Modifier? Replacement and repair
What Is A RT Modifier? Right Side – Used to identify procedures performed on the right side of the body.
What Is A RR Modifier? Rental (use the RR modifier when DME is a rental)
Modifiers SB NP
What Is A SB NP Modifier?: (for use by midwives only).
What Is A SC Modifier? Medically necessary service or supply (w.e.f Jan 1, 2012).
What Is A SF Modifier? Second opinion ordered by a Professional Review Organization (PRO) per section 9401, P.L. 99-272 (100 % reimbursement – no Medicare deductible or coinsurance)
SG Ambulatory Surgical Center (ASC) modifier.
What Is A SH Modifier? Second concurrently administered infusion therapy
SJ Third or more concurrently administered infusion therapy.
What Is A SK Modifier? Member of high risk population (Use only with codes for immunization).
What Is A SS Modifier? Home infusion services provided in the infusion suite of the IV therapy provider.
What Is A SW Modifier? Services provided by a certified diabetes educator.
What Is A TA Modifier? Left foot, great toe.
What Is A T1 Modifier? Left foot, second digit.
What Is A T2 Modifier? Left foot, third digit
What Is A T3 Modifier?Left foot, fourth digit.
What Is A T4 Modifier? Left foot, fifth digit.
What Is A T5 Modifier? Right foot, great toe.
What Is A T6 Modifier? Right foot, second digit.
What Is A T7 Modifier? Right foot, third digit.
What Is A T8 Modifier? Right foot, fourth digit.
What Is A T9 Modifier? Right foot, fifth digit.
What Is A TC Modifier? Technical component only – Use to indicate the technical part of a diagnostic procedure performed.
What Is A TD Modifier? Registered Nurse (RN) (for behavioral health use).
What Is A TE Modifier? Licensed Practical Nurse (LPN) (for behavioral health use).
What Is A TJ Modifier? Child/Adolescent Program GP: To be used for enhancement payment for foster care children screening exams.
What Is A TK Modifier? Extra member or passenger, nonambulance transportation.
What Is A TR Modifier? School-based individualized education program services provided outside the public school district responsible for the student.
What Is A TS Modifier?Follow-up service.
What Is A UE Modifier? Used durable medical equipment.
What Is A UN Modifier? Portable X-ray Modifiers; two patients.
What Is A UP Modifier? Portable X-ray Modifiers; three patients.
What Is A UQ Modifier? Portable X-ray Modifiers; four patients.
What Is A UR Modifier? Portable X-ray Modifiers; five patients.
Modifier US: Portable X-ray Modifiers; six patients.
What Is A V1 Modifier? Level of MMI for Treating Doctor – This modifier would be added to the “Work related or medical disability examination by the treating physician…” CPT code 99455 when the office visit level of service is equal to a “minimal” level.
What Is A V2 Modifier? Level of MMI for Treating Doctor – This modifier would be added to the “Work related or medical disability examination by the treating physician…” CPT code 99455 when the office visit level of service is equal to “self limited or minor” level.
What Is A V3 Modifier? Level of MMI for Treating Doctor – This modifier would be added to the “Work related or medical disability examination by the treating physician…” CPT code 99455 when the office visit level of service is equal to “low to moderate” level.
What Is A V4 Modifier? Level of MMI for Treating Doctor – This modifier would be added to the “Work related or medical disability examination by the treating physician…” CPT code 99455 when the office visit level of service is equal to “moderate to high severity” level and of at least 25 minutes duration.
What Is A V5 Modifier? Level of MMI for Treating Doctor – This modifier would be added to the “Work related or medical disability examination by the treating.. Read more..
What Is A 6 Modifier? Arteriovenous Graft (or other vascular access not including a vascular.. Read more..
What Is A V7 Modifier? Afteriovenous Fistula (or other vascular access not including a vascular.. Read more..
What Is A V8 Modifier? Dialysis related infection present during the billing month – Part A only modifier.
Usage of Modifier V8: Reportable dialysis access-related infection is limited to peritonitis for peritoneal dialysis patients or bacteremia for hemodialysis patients. Facilities must report any peritonitis related to a peritoneal dialysis catheter and.. Read more..
What Is A V9 Modifier? No dialysis related infection present during the billing month – Part A only modifier.
Usage of Modifier V9: No dialysis-access related infection, as defined for modifier V8, is present during the billing month. Dialysis access-related infection, defined as peritonitis for peritoneal dialysis patients or bacteremia for.. Read more..
What Is A VR Modifier? Review report – This modifier shall be added to the “Work related or medical disability examination by the treating physician…” CPT code 99455 to indicate that the service was the treating doctor’s review of report(s) only.
What Is A XE Modifier? Separate Encounter, A Service That Is Distinct Because It Occurred During.. Read more..
What Is A XS Modifier? Separate Structure, A Service That Is Distinct Because It Was Performed.. Read more..
What Is A XP Modifier? Separate Practitioner, A Service That Is Distinct Because It Was Performed By.. Read more..
What Is A XU Modifier? Unusual Non-Overlapping Service, The Use Of A Service That Is.. Read more..
What Is A ZA Modifier? (Anesthesia modifier especially used for Medi-cal insurance of California) denotes prone position or surgical field avoidance. To be used only for procedures that have a base value of three (3) units. These techniques are included in the anesthesia base value of surgical procedures with a base value of more than three.
What Is A ZE Modifier? (Anesthesia modifier especially used for Medical insurance of California) To be billed with the appropriate five-digit CPT-4 anesthesia code to identify a normal, uncomplicated anesthesia provided by a Certified Registered Nurse Anesthetist (CRNA).
Note: Please check the respective insurance guidelines for appropriate usage of Modifiers to avoid denials.