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Modifiers - Complete List

Vijayarani Sivakumar

Published On - October 22, 2020

CPT Modifiers

Category II modifiers

Anesthesia Physical Status Modifiers

HCPCS Modifiers

Ambulance Modifiers  - HCPCS Level II Modifiers

List of CPT & HCPCS MODIFIERS

Modifiers Definition


A modifier provides the means by which the reporting provider can indicate that a service or procedure that has been performed has been altered by some specific circumstance but not changed in its definition or code. 



For Medicare purposes, modifiers are two-digit codes that may consist of alpha and/or numeric characters, which may be appended to Healthcare Common Procedure Coding System (HCPCS) procedure codes to provide additional information needed to process a claim. This includes HCPCS Level 1, also known as Current Procedural Terminology® (CPT®) codes, and HCPCS Level II codes. Modifiers answer questions such as: which one, how many, what kind and when.


What is the purpose of using a modifier?

The use of a modifier on a Medicare claim provides additional information for the code being billed and, if approved, may determine the payment for the code.

Why is the correct use of a modifier important?

Several of the top billing errors involve the incorrect use of modifiers. Correct modifier use is an important part of avoiding fraud and abuse or noncompliance issues, especially in coding and billing processes involving government programs.


How does a modifier affect payment?

In some cases, addition of a modifier may directly affect payment. Placement of a modifier after a CPT® or HCPCS code does not ensure reimbursement. Medical documentation may be requested to support the use of the assigned modifier. If the service is not documented or the documentation does not contain all pertinent information and an adequate definition of the procedure or service, it may not be considered appropriate to report the modifier.


What should be understood about modifiers?


The critical thing to remember is that, just because a service is "covered", it does not necessarily mean that service is "reimbursable". A clear understanding of Medicare's rules is necessary to assign modifiers correctly. It is the responsibility of any provider submitting claims to stay informed of Medicare program requirements.



?Modifier # Modifier description 

21 Prolonged Evaluation and Management Services 

22 Unusual Procedural Services 

23 Unusual Anesthesia 

24 Unrelated Evaluation and Management Service by the Same Physician During a Postoperative Period 

25 Significant, Separately Identifiable Evaluation and Management Service by the Same Physician on the Same Day of the Procedure or Other Service 

26 Professional Component 

32 Mandated Services 

47 Anesthesia by Surgeon 

50 Bilateral Procedures 

51 Multiple Procedures 

52 Reduced Services 

53 Discontinued Procedure 

54 Surgical Care Only 

55 Postoperative Management Only 

56 Preoperative Management Only 

57 Decision for Surgery 

58 Staged or Related Procedure or Service by the Same Physician During the Postoperative Period

59 Distinct Procedural Service

62 Two Surgeons 

63 Procedure Performed on Infants less than 4 kg. 

66 Surgical Team 

76 Repeat Procedure by Same Physician 

77 Repeat Procedure by Another Physician 

78 Return to the Operating Room for a Related Procedure During the Postoperative Period 

79 Unrelated Procedure or Service by the Same Physician During the Postoperative Period 

80 Assisted Surgeons 

81 Minimum Assistant Surgeons 

82 Assistant Surgeon (when qualified surgeon no available) 

90 Reference (Outside) Laboratory 

91 Repeat Clinical Diagnostic Laboratory Test 

99 Multiple Modifiers 

P1 A normal healthy patient 

?P2 A patient with mild systemic disease

P3 A patient with severe systemic disease

P4 A patient with severe systemic disease that is a constant threat to life

P5 A moribund patient who is not expected to survive without the operation

P6 A declared brain-dead patient whose orgins are being removed for donor purposes

27 Multiple Outpatient Hospital E/M Encounters on the Same Date

73 Discontinued Out-Patitent Hosptial/Ambulatory Surgery Center (ASC) Procedure Prior to the
Administration of Anesthisia

74 Discontinue Out-Patient Hospital/Ambulatory Surgery Cener (ASC) Procedure After
Administration of Anesthesia

E1 Upper left, eyelid

E2 Lower left, eyelid

E3 Upper right, eyelid

E4 Lower right, eyelid

F1 Left hand, second digit

F2 Left hand, third digit

F3 Left hand, fourth digit

F4 Left hand, fifth digit

F5 Right hand, thumb

F6 Right hand, second digit

F7 Right hand, third digit

F8 Right hand, fourth digit

F9 Right hand, fifth digit

FA Left hand, thumb

GG Performance and payment of a screening mammogram and diagnostic mammogram on the same
patient, same day

GH Diagnostic mammogram converted from screening mammogram on same day

LC Left circumflex coronary artery (Hospitals use with code 92980-92984, 92995, 92996

LD Left anterior descending coronary artery (Hospitals use with codes 92980-92984, 92995, 92996

LT Left side (used to identify procedures performed on the left side of the body)

QM Ambulance service provided under arrangement by a provider of services

QN Ambulance service furnished directly by a provider of services

RC Right coronary artery (hospital use with codes 92980-92984, 92995, 92996

RT Right side (used to identify procedures performed on the right side of the body

T1 Left foot, second digit

T2 Left foot, third digit 

T3 Left foot, fourth digit

T4 Left foot, fifth digit

T5 Right foot, great toe

T6 Right foot, second digit

T7 Right foot, third digit

T8 Right foot, fourth digit

T9 Right foot, fifth digit

TA Left foot, great

AA- Anesthesia services performed by anesthesiologist.

AD- Medical supervision by a physician, more than four concurrent
anesthesia procedures.

AH- Clinical Psychologist (CP) Services. [Used when a medical group employs a CP and bills for the CP’s service.

AJ- Clinical Social Worker (CSW). [Used when a medical group employs a

CSW and bills for the CSW’s service.

AM- Physician, team member service

AS- Physician Assistant, Nurse Practitioner, or Clinical Nurse Specialist services for assistant at surgery.

AT- Acute treatment. [This modifier should be used when reporting a spinal manipulation service

CC- Procedure code changed. [This modifier is used when the submitted
procedure code is changed either for administrative reasons or because an incorrect code was filed.

G1- Most recent urea reduction ratio (URR) reading of less Than 60.

G2- Most recent urea reduction ratio (URR) reading of 60 to 64.9.

G3- Most recent urea reduction ratio (URR) of 65 to 69.9.

G4- Most recent urea reduction ratio (URR) of 70 to 74.9.

G5- Most recent urea reduction ratio (URR) reading of 75 or greater.

G6- ESRD patient for whom less than six dialysis sessions have been provided in a month.

G7- Pregnancy resulted from rape or incest or pregnancy certified by physician as life threatening.

G8- Monitored Anesthesia Care (MAC) for deep complex, complicated, or markedly invasive surgical procedure.

G9- Monitored Anesthesia Care (MAC) for patient who has history of severe cardio- pulmonary condition.

GA- Waiver of Liability Statement on file. (Effective for dates of service on or after October 1, 1995, a physician or supplier should use this modifier
to note that the patient has been advised of the possibility of noncoverage.) If ABN has been issued, use GA.

GB- Claim being re-submitted for payment because it is no longer covered under a global payment demonstration.

GC- This service has been performed in part by a resident under the
direction of a teaching physician.

GE- This service has been performed by a resident without the presence of a teaching physician under the primary care exception.

GJ- "Opt Out" physician or practitioner emergency or urgent service.

GM- Multiple patients on one ambulance trip.

GN- Service delivered personally by a speech-language pathologist or under an outpatient speech-language pathology plan of care. (SLP)

GO- Service delivered personally by an occupational therapist or under an outpatient occupational therapy plan of care. (OT)

GP- Service delivered personally by a physical therapist or under an outpatient physical therapy plan of care. (PT)

GQ- Via asynchronous telecommunications system

GV- Attending physician not employed or paid under arrangement by the patient’s hospice provider.

GW- Service not related to the hospice patient’s terminal condition.
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GX – Modifier associated with ABN Modifier GX is defined as a “notice of liability issued, voluntary under payer policy” and should be used when a voluntary ABN is issued to a beneficiary.

GY- Item or service statutorily excluded or does not meet the definition of any Medicare benefit.

GZ- Item or service expected to be denied as not reasonable and necessary---------------(Used when no ABN is signed by beneficiary.)

KO- Single drug unit dose formulation.

KP - First drug of a multiple drug unit dose formulation.

KQ- Second or subsequent drug of a multiple drug unit dose formulation.

LC- Left circumflex coronary artery.

LD- Left anterior descending coronary artery.

LR- Laboratory round trip.

LS- FDA-monitored intraocular lens implant.

LT- Left Side. (Used to identify procedures performed on the left side of the body.)

Q3- Live kidney donor - Services associated with postoperative medical complications directly related to the donation.

Q4- Service for ordering/referring physician qualifies as a service exemption.

Q5- Service furnished by a substitute physician under a reciprocal billing arrangement.

Q6- Service furnished by a locum tenens physician.

Q7- One Class A Finding.

Q8- Two Class B findings.

Q9- One Class B and Two Class C findings.

QA- FDA investigational device exemption.

QB- Physician providing service in a rural Health Professional Shortage area

GT- Via interactive audio and video telecommunication systems.

QC- Single channel monitoring.

QD- Recording and storage in solid state memory by digital recorder.

QK- Medical direction of two, three, or four concurrent anesthesia procedures involving qualified individuals (used by anesthesiologist).

QL- Patient pronounced dead after ambulance called.

QM- Ambulance service provided under arrangement by a provider of services.

QN- Ambulance service furnished directly by a provider of services.

QS- Monitored anesthesia care service.

QT- Recording and storage on a tape by an analog tape recorder.

QU- Physician providing service in an urban Health Professional Shortage Area (HPSA).

QV- Item or service provided as routine care in a Medicare qualifying clinical
trial.

QW- Clinical Laboratory Improvement Amendment (CLIA) waived test (modifier used to identify waived tests).

QX- CRNA service with medical direction by a physician (used by CRNA).

QY- Anesthesiologist medically directs one CRNA.

QZ- CRNA service without medical direction by a physician.

RC- Right coronary artery.

RT- Right Side (used to identify procedures performed on the right side of the body).

SF- Second opinion ordered by a Professional Review Organization (PRO)

SG- Ambulatory Surgical Center (ASC) facility service.

TC- Technical Component.

U1 Perinatal care provider completed prenatal or postpartum depression screening and behavioral health need identified (positive screen)

U2 Perinatal care provider completed prenatal or postpartum depression screening with no  behavioral health need identified (negative screen)

U3 Pediatric provider completed postpartum depression screening during well-child or infant  episodic visit and behavioral health need identified (positive screen)

U4 Pediatric provider completed postpartum depression screening during well-child or infant  episodic visit with no behavioral health need identified (negative screen)

HQ Group counseling, at least 60-90 minutes

TF Intermediate level of care, at least 45 minutes

HA Service Code 90791 must be accompanied by this modifier to indicate that the Child and Adolescent Needs and Strengths is included in the assessment. This modifier may be billed only by psychiatrists.

PA Surgical or other invasive procedure on wrong body part

PB Surgical or other invasive procedure on wrong patient

PC Wrong surgery or other invasive procedure on patient

PT modifier  - Colorectal cancer screening test; converted to diagnostic test or other procedure.

PD - Diagnostic or related non-diagnostic item or service provided in a wholly owned or wholly operated entity to a patient who is admitted as an inpatient within 3 days, or 1 day. (New modifier for the year 2012, Check for Usage and reimbursement)

Modifier Usage Guidelines

To ensure you receive the most accurate payment for services you render, Blue Cross recommends using modifiers when you file claims. For Blue Cross claims filing, modifiers, when applicable, always should be used by placing the valid CPT or HCPCS modifier(s) in Block 24D of the CMS-1500 claim form. A complete list of valid modifiers is listed in the most current CPT or HCPCS code book. Please ensure that your office is using the current edition of the code book reflective of the date of service of the claim. If necessary, please submit medical records with your claim to support the use of a modifier.


Please use the following tips to avoid the possibility of rejected claims:

• Use valid modifiers. Blue Cross considers only CPT and HCPCS modifiers that appear in the current CPT and HCPCS books as valid.

• Indicate the valid modifier in Block 24D of the CMS-1500. We collect up to four modifiers per CPT and/or HCPCS code.

• Do not use other descriptions in this section of the claim form. In some cases, our system may read the description as a set of modifiers and this could result in lower payment for you.

• Avoid excessive spaces between each modifier.

• Do not use dashes, periods, commas, semicolons or any other punctuation in the modifier portion of Block 24D.

Most Used Modifier with detailed description

22—Increased Procedural Services: Documentation is required when billing with this modifier. A short explanation of why this modifier was applied will also help expedite the processing of claims.

24—Unrelated E&M Service by Same Physician During a Postoperative Period: Used when a physician performs an E&M service during a postoperative period for a reason(s) unrelated to the original procedure.

25—Significant, Separately Identifiable E&M Service by the Same Physician on the Same Day of the Procedure or Other Service: Used by provider to indicate that on the same date of service, the provider performed two significant, separately identifiable services that are not “unbundled”.

26 or PC—Professional Component: Certain procedures are a combination of a physician component and a technical component, and this modifier is used when the physician is providing only the interpretation portion. TC—Technical Component: Certain procedures are a combination of a provider component and a technical component, and this modifier is used when the provider is performing only the technical portion of a service.

32—Mandated Services: Services related to mandated consultation and/or related services (e.g., third party payer, governmental, legislative, or regulatory requirement) may be identified by adding modifier 32 to the basic procedure.

47—Anesthesia by Surgeon: Regional or general anesthesia provided by a surgeon may be reported by adding this modifier to the surgical procedure. Amount allowed is 25% of the surgical procedure allowance.

82 Insurance Health Plans Revised September 9, 2016. Replaces all prior versions.

62—Two Surgeons (MD, DMD, DO): When two surgeons work together as primary surgeons performing distinct part(s) of a single procedure, each surgeon should add modifier 62 to the Procedure  code. The combined allowable for co-surgeons is 125% of the full Procedure  allowable. This amount will be split 50-50 between the two surgeons, unless otherwise indicated on the claim form.

63—Procedure Performed on Infants less than 4kg: Documentation is required when billing with this modifier. A short explanation of why this modifier was applied will also help expedite the processing of claims.

66—Surgical Team (MD, DO, PA, CRNFA, RN, SA): When a team of surgeons (two or more) are required to perform a specific procedure, each surgeon bills the procedure with modifier 66. Fee allowance is increased to 120% of the basic fee allowance for the procedure.


76—Repeat Procedure by Same Physician: This modifier is used to indicate that a repeat procedure on the same day was necessary, or a repeat procedure was necessary and it is not a duplicate bill for the original surgery or service.

77—Repeat Procedure by Another Physician: This modifier is used to indicate that a procedure already performed by another physician is being repeated by a different physician. This sometimes occurs on the same date of service.

78—Return to the OR for a Related Procedure During the Post-op Period: Indicates that a surgical procedure was performed during the post-op period of the initial procedure, was related to the first procedure, and required use of the operating room. This modifier also applies to patients returned to the operating room after the initial procedure, for one or more additional procedures as a result of complications. Documentation is required when billing with this modifier.

79—Unrelated Procedure or Service by the Same Physician During the Post-op Period:Indicates that an unrelated procedure was performed by the same physician during the post-op period of the original procedure.

80—Assistant Surgeon (MD, DMD, DO): Only one first assistant may be reimbursed for a Procedure  code, except for open-heart surgery, where two assistants are allowed. Payment will be allowed only if an assistant surgeon is allowed by our claims editing system. The fee allowance is automatically reduced to 20% of the surgical fee allowance as billed by the primary surgeon. Refer to Surgical Assistant Guidelines 11.5.3 of the Provider Manual.


50—Bilateral Procedures: Bilateral surgeries are procedures performed on both sides of the body during the same operative session or on the same day. Unless otherwise identified, bilateral procedures should be  identified with this modifier. A separate procedure code should be billed for each procedure, using modifier -50 on the second one. Refer to Bilateral Procedures 11.5.1 of the Provider Manual.

51—Multiple Procedures: Procedures performed at the same operative session, which significantly increase time. Multiple procedures should be listed according to value. The primary procedure should be of the greatest value and should not have modifier -51 added. Subsequent procedures should be listed using modifier -51 in decreasing value. Refer to Bilateral Procedures 11.5.2 of the Provider Manual.

52—Reduced Services: Allowed amount to be reduced to 80% (cut by 20%), then processed according to the contract benefits.

53—Discontinued Procedure: Under certain circumstances, the physician may elect to terminate a surgical or diagnostic procedure. Allowed amount will be reduced to 75% (cut by 25%), then processed according to contract benefits.

54—Surgical Care Only: Used with surgery procedure codes with a global surgery period only. Fee allowance is reduced to 70% of the original allowed. See modifiers 55 and 56 below for additional details on pre- and post-op care only.

55—Postoperative Management Only: Reimbursement is limited to the post-op management services only. Used with the surgery Procedure  code, auto adjudication reduces fee allowance to 30% of the total allowed.

56—Preoperative Management Only: Reimbursement is limited to the pre-op management services only. Used with the surgery Procedure  code, auto adjudication reduces fee allowance to 10% of the total allowed.

57—Decision for Surgery: This modifier identifies an E&M service(s) that resulted in the initial decision for surgery and are not included in the “global” surgical package.

59—Distinct Procedural Service: Indicates that a procedure or service was distinct or independent from other services performed on the same day. Example: An E&M service for an ear infection and a surgical code billed for removal of a wart at the same visit.

81—Minimum Assistant Surgeon (CNM, CRNFA, NP, PA, RN, SA): Use this modifier when the services of a second or third assistant surgeon are required during a procedure. Use with surgical Procedure  codes only. The allowance is automatically reduced to 10% of the surgical fee allowance as billed by the primary surgeon.

82—Assistant Surgeon: This modifier is used when a qualified resident surgeon is not available. This is a rare occurrence. The fee allowance is automatically reduced to 20% of the surgical fee allance as billed by the primary surgeon.

90—Reference (Outside) Laboratory: This modifier is used when laboratory procedures are performed by a party other than the treating or reporting physician. Allowed should fall to contracted lab fees.

91—Repeat Clinical Diagnostic Laboratory Test: This modifier is used when a provider needs to obtain additional test results to administer or perform the same test(s) on the same day and same patient. It should not be used when the test(s) are rerun due to specimen or equipment error or malfunction. Nor should this code be used when basic procedure code(s) (such as Procedure  82951) indicate that a series of test results are to be obtained.

99—Multiple Modifiers: Under certain circumstances two or more modifiers may be necessary to completely describe a service.

JW—JW Modifier is now billable for single dose medications purchased for a specific patient when a portion must be discarded.


 SG—Ambulatory Surgery Center: This modifier is used when the services billed were provided at an Ambulatory Surgery Center (ASC).

SU—Procedure performed in physician’s office (to denote use of facility and equipment) CMS has defined four new HCPCS modifiers to selectively identify subsets of Distinct Procedural Services (-59 modifier) as follows (effective January 1, 2015):

• XE—Separate Encounter, A Service That Is Distinct Because It Occurred During A Separate Encounter

• XS—Separate Structure, A Service That Is Distinct Because It Was Performed On A Separate Organ/ Structure

• XP—Separate Practitioner, A Service That Is Distinct Because It Was Performed By A Different Practitioner

• XU—Unusual Non-Overlapping Service, The Use Of A Service That Is Distinct Because It Does Not Overlap Usual Components Of The Main Service Your Insurance Provider Service Representative is available any time you have a question or concern.

Level I (CPT) Modifiers

-25, -27, -50, -52, -58, -59, -73, -74, -76, -77, -78, -79, -91


Level II (HCPCS) Modifiers

-CA, -E1, -E2, -E3, -E4, -FA, -FB, -FC, -F1, -F2, -F3, -F4, -F5, -F6, -F7, -F8, -F9, -GA, -GG, -GH, -GY, -GZ, -LC, -LD, -LT, -QL, -QM, -RC, -RT, -TA, -T1, -T2, -T3, -T4, -T5, -T6, -T7, -T8, -T9


Therapy Modifiers

Used to identify type of therapy service and level of functional impairment

Outpatient Therapy Code Modifiers – Identify discipline of plan of care under which service is delivered

Modifier Description

GN Services delivered under an outpatient speech language pathology plan of care
GO Services delivered under an outpatient occupational therapy plan of care
GP Services delivered under an outpatient physical therapy plan of care
KX Used to indicate the services rendered are medically necessary

Therapy Functional Modifiers – Used in conjunction with function related G series codes for physical therapy (PT), occupation therapy (OT) and speech language pathology (SLP) to indicate severity/complexity of beneficiary's percentage of functional impairment as determined by clinician furnishing therapy services

Modifier Modifier Description

CH 0 percent impaired, limited or restricted
CI At least 1 percent but less than 20 percent impaired, limited or restricted
CJ At least 1 percent but less than 20 percent impaired, limited or restricted
CK At least 40 percent but less than 60 percent impaired, limited or restricted
CL At least 60 percent but less than 80 percent impaired, limited or restricted
CM At least 80 percent but less than 100 percent impaired, limited or restricted
CN 100 percent impaired, limited or restricted


PORTABLE XRAY HCPCS Modifier Description

UN Two patients served (used with procedure R0075)

UP Three patients served (used with procedure R0075)

UQ Four patients served (used with procedure R0075)

UR Five patients served (used with procedure R0075)

US Six or more patients served (used with procedure R0075)



POSITION EMISSION TOMOGRAPHY (PET) SCAN HCPCS Modifier Description 

PI Initial Anti-tumor Treatment Strategy

PS Subsequent Treatment Strategy

PROSTHETICS HCPCS Modifier Description

EP Modifier - For the purpose of Medicaid, the EP modifier is attached to the Health Check CPT codes for periodic and interperiodic screening assessments. There are very specific guidelines on how and where this modifier is used.

Append modifier EP to all immunization administration codes billed for Medicaid recipients in the Health Check age range, 0 through 20 years of age. 

4. Do NOT append the EP modifier to the vaccine CPT codes. 

For Medicaid recipients 21 years of age and older (above the Health Check age range), the immunization administration codes have not changed. Bill the series of CPT codes 90471 through 90474 without the EP modifier. 

HM Less than Bachelor’s degree level

HN Bachelor’s degree level

HO Master’s degree level

HP Doctoral level

HQ Group setting (for behavioral health use)

HT Multidisciplinary team (for behavioral health use) 

HCPCS Level II Ambulance Service Modifiers:

 HCPCS Level II ambulance service modifiers represent where the patient was picked up and where the patient was dropped off. They are two letters, like all other HCPCS Level II modifiers, but the first letter represents where the patient was picked up and the second letter represents where the patient was transported to or dropped off. The locations and letters are found at the beginning of the A-section of the HCPCS manual.

GENETIC TESTING MODIFIERS

Neoplasia (solid tumor)

0A BRCA1 (Hereditary breast/ovarian cancer)
0B BRCA2 (Hereditary breast cancer)
0C Neurofibromin (Neurofibromatosis, type 1)
0D Merlin (Neurofibromatosis, type 2)
0E c-RET (Multiple endocrine neoplasia, types 2A/B,
familial medullary thyroid carcinoma
0F VHL (Von Hippel Lindau disease)
0G SDHD (Hereditary paraganglioma)
0H SDHB (Hereditary paraganglioma)
0I Her-2/neu
0J MLH1 (HNPCC)
0K MSH2 (HNPCC)
0L APC (Hereditary polyposis coli)
0M Rb (Retinoblastoma)
1Z Solid tumor, not otherwise specified

Neoplasia (lymphoid/hematopoetic)

2A AML1 – also ETO (Acute myeloid leukemia)
2B BCR – also ABL (Chronic myeloid, acute lymphoid leukemia)
2C CGF1
2D CBF beta (Leukemia)
2E ML (Leukemia)
2F PML/RAR alpha (Promyeleocytic leukemia)
2G TEL (Leukemia)
2H bcl-2 (Lymphoma)
2I bcl-1 (Lymphoma)
2J c-yc (Lymphoma)
2K lgH (Lymphoma/leukemia)
2Z Lymphoid/hematopoetic neoplasia not otherwise specified
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NEW MODIFIERS ----2018

wo new modifiers were created to identify services as habilitative or rehabilitative, as follows (appearing in the 2018 CPT Book):

Modifier 96 Habilitative Services: When a service or procedure that may either be habilitative in nature or rehabilitative in nature is provided for habilitative purposes, the physician or other qualified healthcare professional may add modifier 96- to the service or procedure code to indicate that the service or procedure provided was habilitative. Such services help an individual learn skills and functioning for daily living that the individual has not yet developed, and then keep or improve those learned skills. Habilitative services also help an individual keep, learn, or improve skills and functioning for daily living.

Modifier 97 Rehabilitative Services: When a service or procedure that may be either habilitative or rehabilitative in nature is provided for rehabilitative purposes, the physician or other qualified healthcare professional may add modifier 97- to the service or procedure code to indicate that the service or procedure provided was rehabilitative. Rehabilitative services help an individual keep, get back, or improve skills and functioning for daily living that have been lost or impaired because the individual was sick, hurt, or disabled.

These two modifiers are intended to be reported with services that are identified as being either habilitative or rehabilitative in nature, such as physical medicine and rehabilitation codes, allowing the payer the ability to differentiate habilitative from rehabilitative services. This differentiation is required by the Patient Protection and Affordable Care Act (PPACA). 

PAYMENT STATUS INDICATORS

LIST OF MODIFIERS USED IN CODING

LIST OF MODIFIERS:-

Modifier - as the name implies a modifier will modify a service / procedure or an item under certain circumstances for appropriate reimbursement. Modifiers may add information or change the description according to the physician documentation to give more specificity for the service or procedure rendered. Appending of an appropriate modifier will effectively respond to reimbursement.

Modifier are two digit codes and are categorized into two levels

1. Level I Modifiers: Normally known as CPT Modifiers and consists of two numeric digits and are updated annually by AMA - American Medical Association. 

2. Level II Modifiers: Normally known as HCPCS Modifiers and consists 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 the above levels of Modifiers are recognized nationally.

List of Level I Modifiers:
 
Modifier -21 Prolonged Evaluation and Management Services (Deleted, please use CPT 99354- 99359)

Modifier -22 Unusual Procedural Services

Modifier -23 Unusual Anesthesia

Modifier -24 Unrelated Evaluation and Management Service by the Same Physician during a Postoperative Period

Modifier -25 Significant, Separately Identifiable Evaluation and Management Service by the Same Physician on the Same Day of the Procedure or Other Service

Modifier -26 Professional Component 

Modifier -27 Multiple Outpatient Hospital E/M Encounters on the Same Date. 

Modifier -29 Global procedures, those procedures where one provider is responsible for both the professional and technical component. This modifier has been deleted. If a provider is billing for a global service, no modifier is necessary.

Modifier -32 Mandated Services

Modifier -33 Preventive Service

Modifier -47 Anesthesia by Surgeon

Modifier -50 Bilateral Procedure

Modifier -51 Multiple Procedures

Modifier -52 Reduced Services 

Modifier -53 Discontinued Procedure

Modifier -54 Surgical Care Only

Modifier -55 Postoperative Management Only

Modifier -56 Preoperative Management Only

Modifier -57 Decision for Surgery

Modifier -58 Staged or Related Procedure or Service by the Same Physician During the Postoperative Period

Modifier -59 Distinct Procedural Service

Modifier -62 Two Surgeons

Modifier -63 Procedure Performed on Infants less than 4kg

Modifier -66 Surgical Team

Modifier -73 Discontinued Outpatient Hospital/Ambulatory Surgery Center (ASC) Procedure prior to the Administration of Anesthesia

Modifier -74 Discontinued Outpatient Hospital/Ambulatory Surgery Center (ASC) Procedure after Administration of Anesthesia

Modifier -76 Repeat Procedure by Same Physician

Modifier -77 Repeat Procedure by Another Physician

Modifier -78 Return to the Operating Room for a Related Procedure During the Postoperative Period

Modifier -79 Unrelated Procedure or Service by the Same Physician During the Postoperative Period

Modifier -80 Assistant Surgeon

Modifier -81 Minimum Assistant Surgeon

Modifier -82 Assistant Surgeon (when qualified resident surgeon not available)

Modifier -90 Reference (Outside) Laboratory

Modifier -91 Repeat Clinical Diagnostic Laboratory Test

Modifier -92 Alternative Laboratory Platform Testing

Modifier -99 Multiple Modifiers

List of Level II Modifiers: 

AA Anesthesia services personally performed by anesthesiologist. 

AD Medical supervision by a physician: More than 4 concurrent anesthesia procedures.

AE Registered Dietician

AF Specialty Physician

AG Primary Physician

AH Clinical Psychologist

AI Principal Physician of Record

AJ Clinical Social Worker

AK Non Participating Physician

AM Physician, team member service

AP Determination of refractive state was not performed in the course of diagnostic ophthalmological examination.

AQ Service performed in a Health Professional Shortage Area

AR Physician providing services in a physician scarcity area

AS Physician Assistant, Nurse Practitioner, or Clinical Nurse Specialist services for assistant-at-surgery, non-team member.

AT Acute treatment (chiropractic claims) - This modifier should be used when reporting CPT codes 98940, 98941, 98942 or 98943 for acute treatment.

AU Item furnished in conjunction with a urological, ostomy, or tracheostomy supply

AV Item furnished in conjunction with a prosthetic device, prosthetic or orthotic

AW Item furnished in conjunction with a surgical dressing

AX Item furnished in conjunction with dialysis services

AY Item or service furnished to an ESRD patient that is not for the treatment of ERSD

AZ Physician providing a service in a dental Health Professional Shortage Area for the purpose of an Electronic Health Record Incentive Payment

A1 Dressing for one wound

A2 Dressing for two wounds

A3 Dressing for three wounds

A4 Dressing for four wounds

A5 Dressing for five wounds

A6 Dressing for six wounds

A7 Dressing for seven wounds

A8 Dressing for eight wounds

A9 Dressing for nine or more wounds

BA Item furnished in conjunction with parenteral enteral nutrition (PEN) services

BL Special Acquisition of blood and blood products

CA Procedure payable only in the inpatient setting when performed emergently on an outpatient who expires prior to admission.

CB Services ordered by a dialysis facility physician as part of the ESRD beneficiary's dialysis benefit.

CC Procedure code change- CARRIER USE ONLY - Used by carrier to indicate that the procedure code submitted was changed either for administrative reasons or because an incorrect code was filed. 

Automated Multi-Channel Chemistry (AMCC) Tests Modifiers - Effective date: Claims processed on or after April 5, 2010

CD – AMCC test has been ordered by an ESRD facility or MCP physician that is part of the composite rate and is not separately billable.

CE – AMCC tests has been ordered by an ESRD facility or MCP physician that is a composite rate test but is beyond the normal frequency covered under the rate and is separately reimbursable based on medical necessity.

CF – AMCC tests has been ordered by an ESRD facility or MCP physician that is not part of the composite rate and is separately billable.

Reference: http://www.cms.gov/MLNMattersArticles/downloads/MM6683.pdf

Modifiers Used to Report the Severity of Functional Limitations (Effective for the year 2013)

CH 0 percent impaired, limited or restricted

CI At least 1 percent but less than 20 percent impaired, limited or restricted 

CJ At least 20 percent but less than 40 percent impaired, limited or restricted 

CK At least 40 percent but less than 60 percent impaired, limited or restricted  

CL At least 60 percent but less than 80 percent impaired, limited or restricted  

CM At least 80 percent but less than 100 percent impaired, limited or restricted

CN 100 percent impaired, limited or restricted  

Reference: http://www.cms.gov/Outreach-and-Education/Outreach/NPC/Downloads/FunctionalReportingNPC.pdf 

CR Catastrophe/Disaster Related

CS Item or service related, in whole or in part, to an illness, injury, or condition that was caused by or exacerbated by the effects, direct or indirect, of the 2010 oil spill in the Gulf of Mexico, including but not limited to subsequent clean-up activities.

DA Oral health assessment by a licensed Health Professional other than a dentist

EA Erythropetic stimulating agent (ESA) administered to treat anemia due to anti-cancer chemotherapy.

EB Erythropetic stimulating agent (ESA) administered to treat anemia due to anti-cancer radiotherapy.

EC Erythropetic stimulating agent (ESA) administered to treat anemia not due to anti-cancer radiotherapy or anti-cancer chemotherapy.

ED Hematocrit level has exceeded 39% (or Hemoglobin level has exceeded 13.0 G/DL) for 3 or more consecutive billing cycles immediately prior to and including the current cycle

EE Hematocrit level has not exceeded 39% (or Hemoglobin level has not exceeded 13.0 G/DL) for 3 or more consecutive billing cycles immediately prior to and including the current cycle.

E1 Upper left, eyelid

E2 Lower left, eyelid

E3 Upper right, eyelid

E4 Lower right, eyelid

EJ Subsequent claims for a defined course of therapy, e.g., EPO, sodium hyaluronate, infliximab.

EM Emergency reserve supply (for ESRD benefit only)

ET Emergency treatment - Use to designate a dental procedure performed in an emergency situation.

FA Left hand, thumb

F1 Left hand, second digit

F2 Left hand, third digit

F3 Left hand, fourth digit

F4 Left hand, fifth digit

F5 Right hand, thumb

F6 Right hand, second digit

F7 Right hand, third digit

F8 Right hand, fourth digit

F9 Right hand, fifth digit

FB Item provided without cost to provider, supplier or practitioner, or credit received for replaced device (examples, but not limited to covered under warranty, replaced due to defect, free samples)

FC Partial credit received for replaced device

G1 - Most recent URR of less than 60%

G2 - Most recent URR of 60% to 64.9%

G3 - Most recent URR of 65% to 69.9%

G4 - Most recent URR of 70% to 74.9%

G5 - Most recent URR of 75% or greater

G6 - ESRD patient for whom less than seven dialysis sessions have been provided in a month.

G7 Pregnancy resulted from rape or incest or pregnancy certified by physician as life threatening

GA Waiver of liability statement on file - Use to indicate that the physician's office has a signed advance notice retained in the patient's medical record.The notice is for services that may be denied by Medicare.

GC This service has been performed in part by a resident under the direction of a teaching physician.

GD Units of service exceeds medically unlikely edit value and represents reasonable and necessary services.

GE This service has been performed by a resident without the presence of a teaching physician under the primary care exception.

GF Physician services provided by a nonphysician in a critical access hospital; nonphysician: NP, Certified Registered Nurse Anesthetist (CRNA), Certified Registered Nurse (CRN), CNS or PA

GG Diagnostic Mammography - Use to indicated performance and payment of a screening mammography and diagnostic mammography on same patient, on the same day.

GH Diagnostic mammogram converted from screening mammogram on same day

GJ Opted Out physician or practitioner - Use to indicate services performed in an emergency or urgent service.

GM Multiple patients on one ambulance trip

GN Services delivered under an outpatient speech language pathology plan of care.

GO Services delivered under an outpatient occupational therapy plan of care.

GP Services delivered under an outpatient physical therapy plan of care.

GQ Telehealth services via asynchronous telecommunications system

GR This service was performed in whole or in part by a resident in a department of Veterans Affairs Medical Center or clinic supervised in accordance with VA policy.

GS Dosage of EPO or Darbepoietin Alfa has been reduced and maintained in response to hematocrit or hemoglobin level.

GT Telehealth services via interactive audio and video telecommunication systems

GU Waiver of liability statement issued as required by a payer policy, routine notice

GV Attending physician not employed or paid under agreement by the patient's hospice provider.

GW Service not related to the hospice patient's terminal condition.

GY Use to indicate when an item or service statutorily excluded or does not meet the definition of any Medicare benefit.

GZ Use to indicate when an item or service expected to be denied as not reasonable and necessary.Used when no Advanced Beneficiary Notice (ABN) signed by the beneficiary.

HM Less than Bachelor’s degree level

HN Bachelor’s degree level

HO Master’s degree level

HP Doctoral level

HQ Group setting (for behavioral health use)

HT Multidisciplinary team (for behavioral health use) 

Services Funded by by a county, state or federal agency

H9 Court-ordered

HU Funded by child welfare agency

HV Funded state addictions agency

HW Funded by state mental health agency

HX Funded by county/local agency

HY Funded by juvenile justice agency


HZ Funded by criminal justice agency

J1 Competitive Acquisition Program, no-pay submission for a prescription number

J2 Competitive Acquisition Program, restocking of emergency drugs after emergency administration

J3 Competitive Acquisition Program, (CAP) drug not available through CAP as written, reimburse under ASP Methodology

JA Administered intravenously

JB Administered subcutaneoulsly

JC Skin substitute used as a graft

JD Skin substitute NOT used as a graft

JW Drug or biological amount discarded/not administered to any patient

KB Beneficiary requested upgrade for ABN, more than 4 modifiers identified on claim 

KC Replacement of special power wheelchair interface

KD Drug or Biological infused through implanted DME

KE Bid under round one of the DMEPOS competitive bidding program for use with non-competitive bid base equipment

KF Item designated by FDA as Class III device

KL DMEPOS Item Delivered via Mail 

KM Replacement of facial prosthesis - including new impression/moulage

KN Replacement of facial prosthesis - Using previous master model

KR Rental item, durable medical equipment – billing for partial month 

KX Specific required documentation on file (used for DMERC providers)

KZ New Coverage not implemented by managed care

LC Left circumflex coronary artery

LD Left anterior descending coronary artery

LM Left main coronary artery (Effective for the year 2013) 

LR Laboratory Round Trip.

LT Left Side - Used to identify procedures performed on the left side of the body.

M2 Medicare Secondary Payer

NB Nebulizer system, any type, FDA-Cleared fo ruse with specific drug

NU New equipment (DME)

P1 A normal healthy patient

P2 A patient with mild systemic disease

P3 A patient with severe systemic disease

P4 A patient with severe systemic disease that is a constant threat to life

P5 A moribund patient who is not expected to survive without the operation

P6 A declared brain-dead patient whose organs are being removed for donor purposes 

PA Surgery Wrong Body Part

PB Surgery Wrong Patient

PC Wrong Surgery on Patient

 for proper usage of PA, PB and PC Modifiers

PD - Diagnostic or related non-diagnostic item or service provided in a wholly owned or wholly operated entity to a patient who is admitted as an inpatient within 3 days, or 1 day. (New modifier for the year 2012, Check for Usage and reimbursement)

PI PET Tumor init tx strategy

PS PET Tumor subsq tx strategy

PT Colorectal cancer screening test; converted to diagnostic test or other procedure

PO Services, procedures and/or surgeries provided at off-campus provider-based outpatient departments

Q0 Investigational clinical service provided in a clinical research study that is in an approved clinical research study.

Q1 Routine clinical service provided in a clinical research study that is in an approved clinical research study.

Q3 Liver Kidney Donor Surgery and Related Services.

Q4 Service for ordering/referring physician qualifies as a service exemption -

Q5 Service furnished by a substitute physician under a reciprocal billing arrangement

Q6 Service furnished by a locum tenens physician

Q7 One CLASS A finding

Q8 Two CLASS B findings

Q9 One CLASS B and two CLASS C findings

QA FDA Investigational device exemption (IDE) - The IDE project number must be included on the claim when modifier QA is billed.

QB Physician service in a rural HPSA.

QC Single channel monitoring.

QD Recording and storage in solid state memory by a digital recorder.
QJ Services/items provided to a prisoner or patient in state or local custody, however the state or local government, as applicable, meets the requirements in 42 CFR 411.4 (B)

QK Medical direction of 2, 3 or 4 concurrent anesthesia procedures involving qualified individuals.

QL Patient pronounced dead after ambulance called

QM Ambulance service provided under arrangement by a provider of services

QN Ambulance service furnished directly by a provider of services

QP Panel test - Documentation is on file showing that the laboratory test(s) was ordered individually or ordered as a CPT-recognized panel other than automated profile codes.

QS Monitored anesthesia care

QT Recording and storage on tape by an analog tape recorder.

QU Physician service in an urban HPSA.

QV Item or service provided as routine care in a medical qualifying clinical trial

QW CLIA Waived Test - Effective October 1, 1996, all new waived tests are being assigned a CPT code (in lieu of a temporary five-digit G- or Q-code).

QX CRNA service with medical direction by physician.

QY Medical direction of one certified registered nurse anesthetist (CRNA) by an anesthesiologist.

QZ CRNA service without medical direction by a physician.

RA Replacement of a DME item, Orthotic or Prosthetic Item
 
RB Replacement of a Part of DME, Orthotic or Prosthetic Item furnished as Part of a Repair

RC Right coronary artery

RD Drug provided to beneficiary, but not, administrated incident-to

RE Furnished in full compliance with FDA-Mandated Risk Evaluation and Mitigation Strategy (REMS)

RI Ramus intermedius (Effective for the year 2013) 

RP Replacement and repair

RT Right Side - Used to identify procedures performed on the right side of the body. 

RR Rental (use the RR modifier when DME is a rental)

SB NP (for use by midwives only) 

SC Medically necessary service or supply (w.e.f Jan 1, 2012)

SF Second opinion ordered by a Professional Review Organization (PRO) per section 9401, P.L. 99-272 (100 % reimbursement – no Medicare deductible or coinsurance)

SG Ambulatory Surgical Center (ASC) modifier 
 

SH Second concurrently administered infusion therapy

SJ Third or more concurrently administered infusion therapy 

SK Member of high risk population (Use only with codes for immunization)

SS Home infusion services provided in the infusion suite of the IV therapy provider

SW Services provided by a certified diabetes educator

TA Left foot, great toe

T1 Left foot, second digit

T2 Left foot, third digit

T3 Left foot, fourth digit

T4 Left foot, fifth digit

T5 Right foot, great toe

T6 Right foot, second digit

T7 Right foot, third digit

T8 Right foot, fourth digit

T9 Right foot, fifth digit

TC Technical component only - Use to indicate the technical part of a diagnostic procedure performed.

TD Registered Nurse (RN) (for behavioral health use)

TE Licensed Practical Nurse (LPN) (for behavioral health use)

TJ  Child/Adolescent Program GP:  To be used for enhancement payment for foster care children screening exams.  

TK Extra member or passenger, nonambulance transportation 

TR School-based individualized education program services provided outside the public school district responsible for the student

TS Follow-up service

UE Used durable medical equipment
 
UN Portable X-ray Modifiers; two patients

UP Portable X-ray Modifiers; three patients

UQ Portable X-ray Modifiers; four patients

UR Portable X-ray Modifiers; five patients

US Portable X-ray Modifiers; six patients 

V1 Level of MMI for Treating Doctor - This modifier would be added to the "Work related or medical disability examination by the treating physician..." CPT code 99455 when the office visit level of service is equal to a "minimal" level. 

V2 Level of MMI for Treating Doctor - This modifier would be added to the "Work related or medical disability examination by the treating physician..." CPT code 99455 when the office visit level of service is equal to "self limited or minor" level. 

V3 Level of MMI for Treating Doctor - This modifier would be added to the "Work related or medical disability examination by the treating physician..." CPT code 99455 when the office visit level of service is equal to "low to moderate" level. 

V4 Level of MMI for Treating Doctor - This modifier would be added to the "Work related or medical disability examination by the treating physician..." CPT code 99455 when the office visit level of service is equal to "moderate to high severity" level and of at least 25 minutes duration. 

V5 Level of MMI for Treating Doctor - This modifier would be added to the "Work related or medical disability examination by the treating physician..." CPT code 99455 when the office visit level of service is equal to "moderate to high severity" level and of at least 45 minutes duration.

V5 Any Vascular Catheter (alone or with any other vascular access) - Part A only modifier

V6 Arteriovenous Graft (or other vascular access not including a vascular catheter) - Part A only modifier

V7 Afteriovenous Fistula (or other vascular access not including a vascular catheter) - Part A only modifier

V8 Dialysis related infection present during the billing month - Part A only modifier

V9 No dialysis related infection present during the billing month - Part A only modifier

VR Review report - This modifier shall be added to the "Work related or medical disability examination by the treating physician..." CPT code 99455 to indicate that the service was the treating doctor's review of report(s) only. 

XE Separate Encounter, A Service That Is Distinct Because It Occurred During A Separate Encounter, 

XS Separate Structure, A Service That Is Distinct Because It Was Performed On A Separate Organ/Structure, 

XP Separate Practitioner, A Service That Is Distinct Because It Was Performed By A Different Practitioner, and 

XU Unusual Non-Overlapping Service, The Use Of A Service That Is Distinct Because It Does Not Overlap Usual Components Of The Main Service.

Modifier ZA (Anesthesia modifier especially used for Medi-cal insurance of California) denotes prone position or surgical field avoidance. To be used only for procedures that have a base value of three (3) units. These techniques are included in the anesthesia base value of surgical procedures with a base value of more than three.

Modifier ZE (Anesthesia modifier especially used for Medi-cal insurance of California) To be billed with the appropriate five-digit CPT-4 anesthesia code to identify a normal, uncomplicated anesthesia provided by a Certified Registered Nurse Anesthetist (CRNA).

Note: Please check the respective insurance guidelines for appropriate usage of Modifiers to avoid denials.