This CPT modifiers list consists of descriptions and billing guidelines for category I, category II, and category III modifiers from Current Procedural Terminology.
What Is A CPT Modifier?
CPT modifiers modify a service/procedure or an item under certain circumstances for appropriate reimbursement.
Modifiers add information or change the description according to the physician’s documentation to give more specificity to the service or procedure rendered.
Appending an appropriate modifier will effectively respond to reimbursement.
Modifiers In Medical Billing
Modifiers in medical billing are two-digit codes and divided into two levels:
CPT Modifiers: Normally known as CPT modifiers or CPT code modifiers and consist of two numeric digits and are updated annually by AMA (American Medical Association).
Level II HCPCS Modifiers: Normally known as HCPCS Modifiers and consist 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 levels of modifiers are recognized nationally.
Categories Of CPT Modifiers
There are three categories of modifiers. Category I are “provider services and ambulatory service center” modifiers and range from modifier 22 until modifier 99.
The second category of CPT code modifiers are the so-called “performance measurement modifiers” and can only be used in category I or category II modifiers that can’t be reported.
The third category can be used for anesthesia services and are called “anesthesia physical status” modifiers.
The CPT modifiers list with descriptions and guidelines can be found below.
CPT Modifier List For Provider Services And Ambulatory Service Centers
Below is the category I modifier list for provider services and ambulatory service centers. This list of modifiers ranges from 22 to 99.
Modifier 21 (DELETED)
What is modifier 21? Prolonged evaluation and management services.
Note: Modifier 21 was deleted on 01-01-2009. Please use CPT 99354 – CPT 99359 instead.
When to use a 21 modifier? (DELETED) 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..
What is modifier 22? Increased procedural services.
When to use a 22 modifier? Modifier 22 is attached to the service when the Physician performs enhanced procedural service than the usual time required to complete the procedure.
Documentation must support the substantial supplementary work and the rationale for the additional work, such.. Read More..
What is modifier 23? Unusual anesthesia.
When to use a 23 modifier? Modifier 23 can be used for a procedure, which requires normally no anesthesia or local anesthesia, and must be done under general anesthesia because of unusual circumstances.
This is considered.. Read more..
What is modifier 24? Unrelated evaluation and management service by the same Physician or other qualified health care professional during a postoperative period.
When to use a 24 modifier? Modifier 24 applies when the physician performs unrelated Evaluation and management services during the global period of 10 or 90 days of surgical procedure.
Documentation should support the.. Read more..
What is modifier 25? A significant, separately identifiable evaluation and management service by the same Physician, or other qualified health care professional on the same day of the procedure/other service.
When to use a 25 modifier? Modifier 25 pays for the physician’s benefits with the highest accuracy level and confirms the physician’s payment according to the physician’s efforts.
If the claim fills.. Read more..
What is modifier 26? Professional component.
When to use a 26 modifier? Modifier 26 appends with the combination of procedures furnished by the Physician or other skilled professional such as a technician.
The technician may perform the service, and the Physician may or may.. Read more..
What is modifier 27? Multiple outpatient hospital E/M (Evaluation & Management Services) encounters on the same date.
When to use a 27 modifier? Use modifier 27 when a patient receives multiple E/M services performed by the same or different physicians in multiple outpatient hospital.. Read more..
Modifier 29 (DELETED)
What is modifier 29? Modifier 29 was used for global procedures. These are services where one provider is responsible for both the professional and a technical component.
Note: Modifier 29 has been deleted. If a provider is billing for a global service, no modifier is necessary.
What is modifier 32? Mandated services.
When to use a 32 modifier? Modifier 32 should be used when services related to mandated consultation and/or related services such as confirmatory consultations and related diagnostic services (eg. third.. Read more..
What is modifier 33? Preventive services.
When to use a 33 modifier? Modifier 33 can be used 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..
What is modifier 47? Anesthesia by surgeon.
When to use a 47 modifier? Modifier 47 is used to report procedure codes for regional or general anesthesia provided by the attending or assistant surgeon.
Add modifier 47 to the basic service. This does not include.. Read more..
What is modifier 50? Bilateral procedure.
When to use a 50 modifier? Use modifier 50 for bilateral services. This are services/procedures performed on both sides of the body during the same operative session or on the same day.
Modifier 50 is not applicable to procedures.. Read more..
What is modifier 51? Multiple procedures.
When to use a 51 modifier? Modifier 51 appends for the service when the same physician performs multiple procedures in a single encounter on the same day.
It frequently bills in surgical service and always append to the secondary.. Read more..
What is modifier 52? Reduced services.
When to use a 52 modifier? Modifier 52 is applicable when the service reduces or is partially performed by the physician or other skilled professional due to unavoidable circumstances.
It usually indicates the service which.. Read more..
What is modifier 53? Discontinued procedure.
When to use a 53 modifier? Modifier 53 is appropriate to report the diagnostic or surgical procedure when the physician discontinues the practice under unavoidable circumstances.
It may terminate due to extenuating circumstances or.. Read more..
What is modifier 54? Surgical care only.
When to use a 54 modifier? 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 modifier 54. Submit the 54 modifier only with.. Read more..
What is modifier 55? Postoperative management only.
When to use a 55 modifier? Use modifier 55 when one physician performed the postoperative management and another physician performed the surgical procedure.
The postoperative component may be identified by adding modifier 55.. Read More..
What is modifier 56? Preoperative management only.
When to use a 56 modifier? Use 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 modifier 56 to.. Read more..
What is modifier 57? Decision for surgery.
When to use a 57 modifier? Modifier 57 applies can be billed for services when the physician provides the evaluation and management service that ensued in the initial decision to perform the surgery.
By adding the 57 modifier to the appropriate.. Read more..
What is modifier 58? A staged or related procedure/service performed by the same physician during the postoperative period.
When to use a 58 modifier? Modifier 58 may apply to surgical services that require more than one session or may require physical therapy service after the.. Read more..
What is modifier 59? Distinct procedural service.
When to use a 59 modifier? Modifier 59 can be used for distinct procedures when no other appropriate modifier is available with the aim to unbundle the services or procedures performed by the Physician on the same day.
The 59 modifier represents the.. Read more..
What is modifier 62? Two surgeons.
When to use a 62 modifier? Modifier 62 can be used for a procedure where two health providers work together as primary surgeons. Both the surgeons perform a distinct part of the procedure that is performed.
What is modifier 63? Procedure performed on an infant less than four kilogram.
When to use a 63 modifier? Modifier 63 can be used for procedures performed by a health provider on a child that weighs less than 8.8 pounds (four kilograms).
Do not report this modifier for CPT codes designated as modifier 63 exempt.
What is modifier 66? Surgical team.
When to use a 66 modifier? Modifier 66 can be used for procedures performed by a surgeon who is part of a surgical team (usually three or more health providers) performing a difficult or complex procedure.
What is modifier 73? Discontinued out-patient hospital/ambulatory surgery center (ASC) procedure prior to the administration of anesthesia.
When to use a 73 modifier? Use modifier 73 when the surgeon terminates a procedure before administering anesthesia.
Bill this modifier only for ambulatory surgery centers or out-patient hospital procedures. Use the 74 modifier if the procedure is terminated after administering anesthesia services.
What is modifier 74? Discontinued out-patient hospital/ambulatory surgery center (ASC) procedure after administration of anesthesia.
When to use a 74 modifier? Use modifier 74 when the surgeon terminates a procedure after administering anesthesia. Report this modifier for ambulatory surgery centers or out-patient hospital procedures only.
The 74 modifier can be reported if the procedure is terminated before administering anesthesia services.
What Is Modifier 76? Repeat procedure/service performed by the same Physician/other qualified health care professional.
When to use a 76 modifier? Use modifier 76 for services or procedures that are repeated by a health provider after the initial procedure. A procedure is usually repeated because a patient did not respond to the initial procedure.
Only report his modifier if the repeated procedure is performed by the same Physician.
Report Modifier 77 instead if the procedure is performed by another health professional.
CPT Modifier 77
What is modifier 77? Repeat procedure by another Physician/other qualified health care professional.
When to use a 77 modifier? Modifier 77 is applied for service when a similar service performs by another physician or healthcare provider on the same day.
If multiple or identical services perform in one day, they bundle with each other. CMS allows.. Read more..
Use modifier 76 instead if the service is performed by the same health professional.
What is modifier 78? Unplanned return to the operating/procedure room by the same physician or other qualified health care professional following initial procedure for a related procedure during the postoperative period.
When to use a 78 modifier? Modifier 78 can be appended with services when the physician does not plan the procedure and the patient returns to the operating room due to complications related to the prior surgery.
For example, the patient.. Read more..
What is modifier 79? Unrelated procedure/service by the same Physician/qualified health care professional during the postoperative period.
When to use a 79 modifier? Modifier 79 can be reported when another unplanned surgery or service is performed by the physician or a skilled professional during the postoperative period of an initial procedure.
For example, the patient had.. Read more..
What is modifier 80? Assistant surgeon.
When to use a 80 modifier? Use modifier 80 when an assistant surgeon assists an operating or a principal surgeon during an entire procedure.
Use modifier 81 if a surgeon assistant only assists during part of the procedure and if this was because a medical resident was unavailable. The assistant surgeon performed tasks under the direct supervision of the principal surgeon.
What is modifier 81? Minimum Assistant Surgeon.
When to use a 81 modifier? Use modifier 81 when an assistant surgeon assists an operating or a principal surgeon during part of a procedure. Use this modifier if they only assisted the entire procedure.
What is modifier 82? Assistant surgeon (when qualified resident surgeon not available).
When to use a 82 modifier? Use modifier 82 when an assistant surgeon assists an operating or a principal surgeon during an entire procedure because a medical resident was unavailable.
What is modifier 90? Reference (outside) laboratory.
When to use a 90 modifier? Use modifier 90 when a pathology or a laboratory test is performed by an outside laboratory instead of the reporting or treating health provider.
CPT Modifier 91
What is modifier 91? Repeat clinical diagnostic laboratory test.
When to use a 91 modifier? Modifier 91 can be used for a repeat lab test. Only report this modifier if the lab test is repeated on the same day for the same patient.
CPT Modifier 92
What is modifier 92? Alternative laboratory platform testing.
When to use a 92 modifier? Use modifier 92 for lab tests in the form of a transportable instrument or kit. The kit or transportable instrument consists of a disposable, analytical, and single-use chamber.
What is modifier 93? Synchronous telemedicine service rendered via telephone or other real-time interactive audio only telecommunications system.
NOTE: Modifier 93 is a new code.
When to use a 93 modifier? Use modifier 93 for services performed on a patient with audio-only technology. Interaction is possible between health providers and patients is possible because of real-time (synchronous) interaction technology.
What is modifier 95? Synchronous telemedicine service rendered via a real-time interactive audio and video telecommunications system.
When to use a 95 modifier? Use modifier 95 for services provided between a provider and patient through real-time audiovisual conference.
What is modifier 96? Habilitative services.
When to use a 96 modifier? Modifier 96 can be used for services when the physician or other skilled/qualified professional offers habilitative and rehabilitative procedures or services for habilitative services in nature.. Read more..
CPT Modifier 97
What is modifier 97? Rehabilitative services.
When to use a 97 modifier? Use modifier 97 when a health provider performs rehabilitative services. The rehabilitative services aim to improve a function or skill from a patient that was lost because of a disease or an injury.
CPT Modifier 99
What is modifier 99? Multiple modifiers.
When to use a 99 modifier? Use modifier 99 when there are already two or more additional modifiers used for a service or procedure. Make sure to use the 99 modifier as the first modifier.
CPT Modifier List For Performance Measurement
Category II modifiers are called “performance measurement modifiers” and indicate that a service was considered but was not provided due to patient, medical or system circumstances.
Report CPT modifiers from category II only if the procedure can not be reported with category I or III.
Below is the list of category II modifiers.
What is modifier 1P? Performance measure exclusion modifier due to medical reasons.
When to use a 1P modifier? Use modifier 1P for a quality reporting code to indicate the medical status of a patient. Only use this modifier when there are medical reasons that keep the health provider from completing an action.
Reasons to use modifier 1P can include:
- Contraindicated. For example: potential adverse drug interaction or patient allergic history.
- Not indicated. For example: absence of limb or organ or already performed or received.
- Other medical reasons.
What is modifier 2P? Performance measure exclusion modifier due to patient reasons.
When to use a 2P modifier? Use modifier 2P for a quality reporting code when the health provider can’t perform a service specified by a quality measure due to patient reasons. An example of a patient reason is refusal.
Reasons to use the 2P modifier can include;
- the patient declined; or
- other reasons.
What is modifier 3P? Performance measure exclusion modifier due to system reasons.
When to use a 3P modifier? Add modifier 3P to a quality reporting code if a provider can’t perform an action due to quality measures specified that are related to a healthcare delivery system.
Reasons to use the 3P modifier can include;
- insurance coverage limitations;
- payor-related limitations;
- resources to perform the services are not available;
- other reasons that are attributable to the health care delivery system.
What is modifier 8P? Performance measure reporting modifier. Action not performed. Reason not otherwise specified.
When to use an 8P modifier? Use the 8P modifier when a health provider did not document a reason for not performing an action on a patient that is specified by the quality measure.
CPT Modifier List For Anesthesia Services
Anesthesia services have to be reported with CPT 00100 until CPT 01999 and a physical status modifier. It is appropriate to include other CPT modifiers as well.
CPT modifiers P1 – P6 can be used for billing anesthesia procedures. Physical status modifiers are represented by a ‘P’ and followed by a digit (1, 2, 3, 4, 5, or 6). Below is the list of category III modifiers.
What is modifier P1? A normal healthy patient.
When to use a P1 modifier? Use modifier P1 for services performed on a normal healthy patient.
What is modifier P2? A patient with mild systemic disease.
When to use a P2 modifier? Use modifier P2 for services performed on a patient with mild systemic disease.
What is modifier P3? A patient with severe systemic disease.
When to use a P3 modifier? Use modifier P3 for services performed on a patient with severe systemic disease.
What is modifier P4? A patient with severe systemic disease is a constant threat to life.
When to use a P4 modifier? Use modifier P4 for services performed on a patient with severe systemic disease that is a constant threat to the patient’s life.
What is modifier P5? A moribund patient is not expected to survive without the operation.
When to use a P5 modifier? Use modifier P5 for an operation performed on a moribund patient who is not expected to survive otherwise.
What is modifier P6? A declared brain-dead patient whose organs are being removed for donor purposes.
When to use a P6 modifier? Use modifier P5 for operations performed on a brain-dead declared patient whose organs are being removed for donor purposes.
Tip: You can find the HCPCS Level II Modifiers list here.