modifier g4

Modifier G1, Modifier G2, Modifier G3, Modifier G4, Modifier G5, Modifier G6 (2021)

Urea Reduction Ratio (URR) Modifiers

G1 Modifier – Most recent URR of less than 60%
G2 Modifier – Most recent URR of 60% to 64.9%
G3 Modifier – Most recent URR of 65% to 69.9%
G4 Modifier – Most recent URR of 70% to 74.9%
G5 Modifier – Most recent URR of 75% or greater
G6 Modifier – ESRD patient for whom less than seven dialysis sessions have been provided in a month.

All hemodialysis claims must indicate the most recent Urea Reduction Ratio (URR) for the dialysis patient. Code all claims using HCPCS code 90999 along with the appropriate G modifier listed above.

Claims for dialysis treatments must include the adequacy of hemodialysis data as measured by URR. Dialysis facilities must monitor the adequacy of dialysis treatments monthly for facility patients. Home hemodialysis and peritoneal dialysis patients may be monitored less frequently, but not less than quarterly. 
If a home hemodialysis patient is not monitored during a month, the last, most recent URR for the dialysis patient must be reported.HCPCS code 90999 (unlisted dialysis procedure, inpatient or outpatient) must be reported in field location 44 for all bill types 72X. The appropriate G-modifier in field location 44 (HCPCS/RATES) is used, for patients that received seven or more dialysis treatments in a month. Continue to report revenue codes 0820, 0821, 0825, and 0829 in field location 43.

For patients that have received dialysis 6 days or less in a month, facilities shall use modifier G6.

For services beginning January 1, 2003, and after, if the modifier is not present, FIs must return the claim to the provider for the appropriate modifier.

Effective April, 2007 due to the requirement of line item billing, at least one revenue code line for hemodialysis on the claim must contain one of the URR modifiers shown above. The URR modifier is not required on every hemodialysis line on the claim.

The techniques to be used to draw the pre- and post-dialysis blood urea Nitrogen samples are listed in the National Kidney Foundation Dialysis Outcomes Quality Initiative Clinical Practice Guidelines for Hemodialysis Adequacy, Guideline 8, Acceptable Methods for BUN sampling, New York, National Kidney Foundation, 2000, pp.53-60.

For additional information visit Dialysis Adequacy, Infection and Vascular Access Reporting


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