Below, you can find a list of all the CPT modifiers. A modifier ‘modifies’ a procedure or item and adds information or changes a description based on the documentation provided by the physician. First, we’ll explain what modifiers are before providing the CPT modifiers list.
CPT modifiers are added to CPT or HCPCS codes to provide additional information to the claim for the insurance payer and aim to clarify the procedure.
For example, additional information is required if a provider performed multiple procedures, if the medical necessity of a procedure needs to be explained, or if a procedure was performed on the right or left side of the body.
The CPT modifiers have two numeric digits, are copyrighted by the American Medical Association, and are updated annually.
The following examples from the CPT book explain appropriate scenarios for appending CPT modifiers to a claim:
- For procedures provided more than once (to the same patient).
- For billing bilateral (two-sided) procedure(s).
- For reduced or increased procedures
- For procedures performed in more than one location.
- For procedures provided by more than one provider.
- For professional and technical components.
Simply put, CPT modifiers add information to a CPT code about why, where, and how the procedure was performed.
The CPT modifiers are divided into three categories. The first category of modifiers ranges from 22 to 99 and is called ‘Provider Services and Ambulatory Service Center Modifiers.’
The second category of CPT modifiers is also known as ‘performance measure modifiers’ or ‘category II modifiers.’ They may be used to indicate that a procedure was considered but not performed due to;
- medical reasons;
- patient reasons;
- system reasons; or
- system circumstances.
The third category of CPT modifiers may be used to describe anesthesia services, known as ‘anesthesia physical status’ modifiers.
2. Modifier 22
Use this modifier for increased procedural services. The circumstances of the surgery need to be unusual and require more mental and/or physical work from the surgeon than usual.
3. Modifier 23
This modifier may be used in procedures with unusual anesthesia. Append this modifier when the provider uses anesthesia for a procedure that usually doesn’t require it.
4. Modifier 24
Append this modifier to an E/M service if a provider performed it during the global surgery period. The E/M must be unrelated to the patient’s surgery.
5. Modifier 25
This modifier may be used when a provider performs an E/M service on a patient on the same day as another procedure or service.
6. Modifier 26
This modifier identifies the professional component of a service and shows that a physician provides the interpretation and supervision of a procedure.
7. Modifier 27
Append this modifier to a subsequent, separate, and distinct E/M service for patients who received multiple E/M services with different providers on the same day and in the same hospital.
8. Modifier 32
This modifier can be appended for mandated services. Third parties, such as a legislative, governmental, or regulatory requirement, mandate that a provider performs a service.
9. Modifier 33
Append this modifier for preventive services. The primary function of a preventive service is to screen for specific diseases. Do not append this modifier to services with the word ‘screening’ in the description (for example, screening mammogram).
10. Modifier 47
Append this modifier to a service or procedure when the performing surgeon also administered general or local anesthesia.
11. Modifier 50
This modifier may be used for bilateral radiology, diagnostic, or surgical procedures. A bilateral procedure is performed on both sides of the patient’s body during the same session.
12. Modifier 51
Append this modifier to multiple subsequent procedures if performed by the same provider, on the same patient, and during the same encounter.
13. Modifier 52
Append this modifier to reduced services. Use this modifier if a provider did not completely perform the procedure described by the code descriptor.
14. Modifier 53
Use this modifier for discontinued procedures. Report this modifier if a surgical or diagnostic procedure is terminated because it threatens the patient’s health.
15. Modifier 54
Report this modifier when a provider performs a procedure but does not provide postoperative or preoperative management.
16. Modifier 55
This modifier may be used when a provider performs postoperative management but they do not provide intraoperative or preoperative services.
17. Modifier 56
This modifier can be appended to a procedure if a provider performs preoperative management only and does not provide postoperative or intraoperative services.
18. Modifier 57
Append this modifier to a code if a provider decides to perform the surgery on the day or the day before the E/M service.
19. Modifier 58
This modifier may be appended to procedures performed during the postoperative period when a procedure is staged or planned.
20. Modifier 59
This is one of the common modifiers and identifies a distinct or independent procedural service from other non–E/M services performed on the same day by the same provider.
21. Modifier 62
Append this modifier for procedures performed by two primary surgeons, performing a distinct part of the procedure.
22. Modifier 63
This modifier can be appended to procedures performed on infants weighing less than four kilograms.
23. Modifier 66
Use this modifier when the provider who performed it was part of a surgical team because the procedure was difficult or highly complex.
24. Modifier 73
Append this modifier for discontinued ambulatory surgery centers or outpatient hospital procedures terminated before anesthesia was provided to the patient.
25. Modifier 74
This modifier can be used for discontinued ambulatory surgery centers or outpatient hospital-terminated procedures after the administration of anesthesia.
26. Modifier 76
You can use this modifier if the same provider repeats a procedure after they performed the initial procedure.
27. Modifier 77
Append this modifier to a code if a different provider repeats a procedure because the initial same procedure was not successful and was performed by another provider.
28. Modifier 78
Use this modifier when you bill a procedure provided by the same provider but unrelated to the initial procedure and performed during the postoperative period.
29. Modifier 79
Append this modifier if an unrelated procedure is performed during the postoperative period, the original procedure by the same provider.
30. Modifier 80
This modifier indicates that an assistant surgeon was present during the procedure and assisted a principal or operating surgeon.
31. Modifier 81
Append this modifier if an assistant surgeon was present during a part of the procedure and assisted a principal or operating surgeon.
32. Modifier 82
Use this modifier if an assistant surgeon was present during the entire procedure and assisted the operating or principal surgeon because a medical resident was unavailable.
33. Modifier 90
This modifier can be used when an outside or reference laboratory performs a pathology or laboratory test instead of the reporting or treating provider.
34. Modifier 91
You can use this modifier for repeated lab tests for the same patient and on the same day.
35. Modifier 92
This modifier identifies a disposable, single-use, transportable lab test or kit with an analytical chamber.
36. Modifier 93
Use this modifier for audio–only technology services that allow synchronous real-time interaction between patient and provider.
37. Modifier 95
Append this modifier for synchronous or real–time audiovisual conference services that allow the provider to provide healthcare from a different location than the patient.
38. Modifier 96
Habilitative services can be identified with this modifier. These services improve, maintain, and develop their skills to perform instrumental activities of daily living (IADLs) or activities of daily living (ADLs).
39. Modifier 97
Rehabilitative services are indicated with this modifier. These services help patients restore or improve functions or skills lost due to disease or illness.
40. Modifier 99
Report modifier 99 as the first modifier on a claim when the service or procedure requires more than one modifier.
41. Modifier 1P
Use this modifier for a quality reporting code if a patient’s medical status prevents the provider from action.
42. Modifier 2P
This modifier indicates that a provider couldn’t act for patient reasons, such as refusal.
43. Modifier 3P
This modifier indicates that the provider did not act due to the healthcare delivery system.
44. Modifier 8P
Report this modifier if a provider could not act but did not specify the reason for not providing the action for a patient.
45. Modifier P1
Report this physical status modifier to identify anesthesia services provided by a physician to a normal and healthy patient.
46. Modifier P2
Report this physical status modifier to identify anesthesia services provided by a physician to a patient with mild systemic disease.
47. Modifier P3
Report this physical status modifier to identify anesthesia services provided by a physician to a patient with severe systemic disease.
48. Modifier P4
Report this physical status modifier to identify anesthesia services a physician provides to a patient suffering from a severe systemic disease that constantly threatens their life.
49. Modifier P5
Report this physical status modifier to identify anesthesia services provided by a physician to a dying patient who is not expected to survive without an operation.
50. Modifier P6
Report this physical status modifier to identify anesthesia services provided by a physician to a dead declared patient whose organs are removed to be donated.
Tip: You can find the HCPCS Level II Modifiers list here.