(2022) Modifier G1, G2, G3, G4, G5 & G6 | Descripions & Billing Guidelines
All hemodialysis claims must indicate the dialysis patient’s most recent Urea Reduction Ratio (URR). Bill all claims with CPT 90999 in conjunction with HCPCS modifier G1, G2, G3, G4, G5, or G6.
1. General Billing Guidelines
Select the proper modifier from G1 to G5 based on the reading. For example, when using modifier G1, you should remember that the provider measures the urea reduction ratio in a hemodialysis patient, and the reading is less than 60.
Watch situations where G1 to G5 are not applicable because of the number of dialysis sessions.
For example, when modifier G6, an ESRD patient for whom less than six dialysis sessions have been provided in a month, applies for Medicare claims instead of the G1 to G5 modifiers due to the number of patient dialysis sessions.
Medicare requires all hemodialysis claims to show a dialysis patient’s most recent urea reduction ratio.
The dialysis facility should monitor the URR monthly in patients who are admitted to the facility. In addition, URR in-home patients’ monitoring should occur at least quarterly.
2. What Is The G1 Modifier?
Append modifier G1 to a code for a hemodialysis patient when the provider measures the urea reduction ratio or URR and the reading is less than 60.
2.1 Description
HCPCS modifier G1 is officially described as follows: “Most recent URR reading of less than 60.”
2.2 Billing Guidelines
Modifier G1 illustrates the measurement of the urea reduction ratio, or URR, in a patient undergoing hemodialysis for end-stage renal disease, or ESRD.
When the kidneys fail to perform their function, dialysis becomes essential to remove waste products from the blood.
The provider tests the patient’s blood to ensure that the dialysis effectively removes waste products.
The provider takes two blood samples, one at the beginning of treatment and the second at the end of dialysis, and compares them.
Any reduction in urea due to dialysis is known as the urea reduction ratio or URR. Use G1 to report a reading of less than 60.
3. What Is The G2 Modifier?
Append modifier G2 to a code for hemodialysis patients when the provider measures the urea reduction ratio, and the reading is 60 to 64.9.
3.1 Description
HCPCS modifier G2 is officially described as: “Most recent URR reading of 60 to 64.9.”
3.2 Billing Guidelines
Report modifier HCPCS G2 to report a URR reading of 60 to 64.9.
4. What Is The G3 Modifier?
Append modifier G3 to a code for hemodialysis patients when the provider measures the urea reduction ratio, and the reading is 65 to 69.9.
4.1 Description
The HCPCS G3 modifier is officially described as follows: “Most recent URR reading of 65 to 69.9.”
4.2 Billing Guidelines
Only report modifier G3 for urea reduction ratio readings between 65 and 69.9.
5. What Is The G4 Modifier?
Append modifier G4 to a code for hemodialysis patients when the provider measures the urea reduction ratio, and the reading is 70 to 74.9.
5.1 Description
HCPCS defines the G4 modifier: “Most recent URR reading of 70 to 74.9.”
5.2 Billing Guidelines
Modifier G4 can only be billed if the most recent urea reduction ratio is between 70 and 74.9.
6. What Is The G5 Modifier?
Append modifier G5 to a code for hemodialysis patients when the provider measures the urea reduction ratio, and the reading is greater than 75.
6.1 Description
The G5 modifier is another HCPCS modifier and is described as: “Most recent URR reading of 75 or greater.”
6.2 Billing Guidelines
HCPCS modifier G5 may only be reported for URR readings of 75 or more.
7. What Is The G6 Modifier?
Append modifier G6 to a code to show that the patient has had fewer than six dialysis sessions in a month. Use this modifier for patients with end-stage renal disease or ESRD.
7.1 Description
The G6 modifier is described by HCPCS as follows: “ESRD patient for whom less than six dialysis sessions have been provided in a month.”
7.2 Billing Guidelines
Modifier G6 represents that a patient has undergone fewer than six dialysis sessions in a month for ESRD. When the kidneys fail to perform their function, dialysis becomes important to remove waste products from the blood.
If the provider confirms the patient had dialysis on fewer than six days in a month, modifier G6 applies.
Watch for when G6 applies for Medicare claims instead of G1 to G5 for urea reduction ratio based on the number of dialysis sessions.
Go back to the list with all HCPCS modifiers.
8. References
https://www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/Downloads/R2134CP.pdf
