HCPCS Severity Modifiers CH, CI, CJ, CK, CL, CM & CL (2022)
HCPCS introduced severity modifiers to identify the functional impairment of a patient. Below we explain what the severity modifiers are and how to use them.
1. What Are The Severity Modifiers?
Severity modifiers show a patient’s functional impairment with a percentage. The functional impairment of a patient is determined by a;
- nonphysician practitioner;
- physician; or
A severity modifier shows the status of the patient, the goal, and the expected discharge status.
Use the modifiers below to report the complexity or severity of the functional measurements of non-payable HCPCS G codes.
2. General Billing Guidelines
The severity modifiers identify the extent of a patient’s impairment. The degree of impairment can be determined with the following percentages;
- 0% for Modifier CH;
- 1-19.9% for Modifier CI;
- 20-39.9% for Modifier CJ;
- 40-59.9% for Modifier CK;
- 60-79.9% for Modifier CL;
- 80-99.9% for Modifier CM; or
- 100% for Modifier CN.
You may report only one functional limitation for every POC (Plan Of Care). Use another G code with one of the severity modifiers if you want to say a second functional limitation.
Functional reporting is needed at the beginning of a care episode or on a date of service (DOS).
After the initial therapy, you can report once per 10 days and on the day the patient is discharged unless the patient needs more treatment. In that case, you can start from the beginning and treat it as a new episode of care.
3. What Is The CH Modifier?
Modifier CH is the first severity modifier and can be used for patients with no (zero) impairment. The patient is restricted or limited in their movements.
The HCPCS book describes the CH modifier as: “0 percent impaired, limited or restricted.”
3.2 Billing Guidelines
Report HCPCS modifier CH for a patient with 0% impairment. The patient can move, but it is limited and restricted. Add this modifier to the non-payable therapy G code.
4. What Is The CI Modifier?
The second severity modifier is the HCPCS modifier CI. You may append this modifier to a G code if the provider determines a patient’s impairment is equal to or more than 1% and less than 20%.
The CI modifier is described in the HCPCS book as follows: “At least 1 percent but less than 20 percent impaired, limited or restricted.”
4.2 Billing Guidelines
This severity modifier can be used with a G code and only for patients with at least 1% impairment and less than 20%. Functional reporting is necessary when a new therapy episode starts.
5. What Is The CJ Modifier?
The third severity modifier is the HCPCS modifier CJ. It reports a patient’s functional limitations in a therapy care plan. Use this modifier for patients with 20% impairment and less than 40%.
The description in the HCPCS book of the CJ modifier is as follows: “At least 20 percent but less than 40 percent impaired, limited or restricted.”
5.2 Billing Guidelines
You can use modifier CJ to the functional measure of a patient for every non-payable therapy G code. A patient impaired is 20% or more and has a maximum of 39.9%. Report modifier CK if the impairment of the patient is 40%.
6. What Is The CK Modifier?
The fourth severity modifier is HCPCS modifier CK. This modifier can be used with a G code to show that the patient’s impairment is at least 40 % and less than 60%.
The HCPCS manual defines modifier CK as: “At least 40 percent but less than 60 percent impaired, limited or restricted.”
6.2 Billing Guidelines
The CK modifier defines how much a patient is impaired. This modifier may be used for a patient with an impairment of 40% and less than 60%.
7. What Is The CL Modifier?
Modifier CL is another HCPCS modifier to report a patient’s impairment in percentages. This modifier can be used during an episode of care and only for patients with 60% and less than 80%.
The HCPCS book defines severity modifier CL as follows: “At least 60 percent but less than 80 percent impaired, limited or restricted.”
7.2 Billing Guidelines
Use this modifier if a patient’s functional impairment is determined by the provider who provided the therapy of at least 60% and less than 80%.
8. What Is The CM Modifier?
Modifier CM identifies the extent of impairment of a patient of 80% and less than 100%.
The HCPCS book describes this fifth severity modifier as: “At least 80 percent but less than 100 percent impaired, limited or restricted.”
8.2 Billing Guidelines
You can use this modifier for specific therapy claims of patients with an 80% or more impairment. Do not use modifier CM for patients who are 100% impaired. Use the modifier CN instead.
9. What Is The CN Modifier?
The CN modifier is the last severity modifier defined by HCPCS. It can be used for patients who are entirely impaired. The provider judged the degree of the patient’s impairment 100%.
HCPCS modifier CN is described in the book as: “100 percent impaired, limited or restricted.”
9.2 Billing Guidelines
This is the last severity modifier attached to a non-payable functional G-code. Report modifier CN for patients who are entirely impaired.
Go back to the list with all HCPCS modifiers.