Modifiers - JA DME
Modifiers
Modifiers can be alphabetic, numeric or a combination of both, but will always be two digits for Medicare purposes. Some modifiers cause automated pricing changes, while others are used to convey information only. They are not required on all HCPCS codes; however, if required and not submitted, the claim will deny as unprocessable.
Most DMEPOS fall into the following categories: Capped Rental, Frequent and Substantial Servicing DME, Inexpensive or Routinely Purchased DME, Oxygen and Oxygen Equipment, Prosthetics and Orthotics and Customized DMEPOS.
Note: To search for a specific modifier, enter "Mod" and the applicable modifier (e.g. Mod KX).
Modifier | Brief Description |
---|---|
99 | Modifier overflow |
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 |
AI | Principal physician of record |
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 |
AY | Item or service furnished to an ESRD patient that is not for the treatment of ESRD |
BA | Item furnished in conjunction with parenteral enteral nutrition (PEN) services |
BO | Orally administered nutrition, not by feeding tube |
BP | The beneficiary has been informed of the purchase and rental options and has elected to purchase the item |
BR | The beneficiary has been informed of the purchase and rental options and has elected to rent the item |
BU | The beneficiary has been informed of the purchase and rental options and after 30 days has not informed the supplier of his/her decision |
CC | Procedure code change (use 'CC' when the procedure code submitted was changed either for administrative reasons or because an incorrect code was filed) (Suppliers should not submit modifier CC) |
CG | Policy criteria applied |
CR | Catastrophe/disaster related |
CS | Cost sharing waiver for COVID-19 testing |
EA | ESA, anemia, chemo-induced |
EB | ESA, anemia, radio-induced |
EC | ESA, anemia, non-chemo/radio |
EJ | Subsequent claims for a defined course of therapy, E.G., EPO, Sodium Hyaluronate, Inflaximab |
EM | Emergency reserve supply (for ESRD benefit only) |
EX | Purchased item/service delivered while an expatriate beneficiary was present in the U.S. |
EY | No physician or other licensed health care provider order for this item or service |
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 |
GA | Waiver of Liability statement on file. Valid Advance Beneficiary Notice of Noncoverage (ABN) obtained. |
GK | Actual item/service ordered by physician, item associated with GA or GZ modifier |
GL | Medically unnecessary upgrade provided instead of standard item, no charge, no Advance Beneficiary Notice of Noncoverage (ABN) |
GS | Dosage of EPO or Darbepoetin alfa has been reduced and maintained in response to hematocrit or hemoglobin level |
GW | Service not related to the hospice patient's terminal condition |
GX | A voluntary Advance Beneficiary Notice of Noncoverage (ABN) has been issued to the beneficiary upon receipt of their DMEPOS item because the item was statutorily noncovered or does not meet the definition of a Medicare benefit. |
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 or necessary (items submitted with GZ are automatically denied and not subject to complex medical review) |
J4 | DMEPOS item subject to DMEPOS competitive bidding program that is furnished by a hospital upon discharge |
J5 | DMEPOS item subject to DMEPOS Competitive Bidding Program that is furnished as part of a professional service by physical or occupational therapists |
JB | Administered subcutaneously |
JK | Short Descriptor: Drug supply 1 month or less; Long Descriptor: One month supply or less of drug or biological |
JL | Short Descriptor: Drug 3-month supply; Long Descriptor: Three-month supply of drug or biological |
JW | Drug amount discarded/not administered to any patient |
JZ | Zero drug amount discarded/not administered to any patient |
K0 | Lower extremity prosthesis functional level 0 - Does not have the ability or potential to ambulate or transfer safely with or without assistance and a prosthesis does not enhance their quality of life or mobility |
K1 | Lower extremity prosthesis functional level 1 - Has the ability or potential to use a prosthesis for transfers or ambulation on level surfaces at fixed cadence. Typical of the limited and unlimited household ambulatory. |
K2 | Lower extremity prosthesis functional level 2 - Has the ability or potential for ambulation with the ability to traverse low level environmental barriers such as curbs, stairs or uneven surfaces. Typical of the limited community ambulator. |
K3 | Lower extremity prosthesis functional level 3 - Has the ability or potential for ambulation with variable cadence. Typical of the community ambulator who has the ability to transverse most environmental barriers and may have vocational, therapeutic or exercise activity that demands prosthetic utilization beyond simple locomotion. |
K4 | Lower prosthesis functional level 4 - Has the ability or potential for prosthetic ambulation that exceeds the basic ambulation skills, exhibiting high impact, stress, or energy levels, typical of the prosthetic demands of the child, active adult, or athlete |
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 though 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 Devices |
KG | DMEPOS item subject to Competitive Bidding Program I |
KH | DMEPOS item, initial claim, purchase or first month rental |
KI | DMEPOS item, second or third month rental |
KJ | DMEPOS item, parenteral enteral nutrition (PEN) pump or capped rental, months four to fifteen |
KK | DMEPOS item subject to Competitive Bidding Program II |
KL | DMEPOS item delivered via mail |
KM | Replacement of facial prosthesis including new impression/moulage |
KN | Replacement of facial prosthesis using previous master model |
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 |
KR | Rental item, billing for partial month |
KS | Glucose monitor supply for diabetic beneficiary not treated with insulin |
KT | Beneficiary resides in a competitive bidding area and travels to a non-competitive bidding area and receives item from a non-contract supplier |
KU | DMEPOS item subject to DMEPOS Competitive Bidding Program Number 3 |
KV | DMEPOS item subject to DMEPOS Competitive Bidding Program that is furnished as part of a professional service |
KW | DMEPOS Item Subject to DMEPOS Competitive Bidding Program Number 4 |
KX | Requirements specified in the medical policy have been met |
KY | DMEPOS Item Subject to DMEPOS Competitive Bidding Program Number 5 |
LT | Left side (Used to identify item provided for the left side of the body) |
MS | Six month maintenance and servicing fee for reasonable and necessary parts and labor which are not covered under any manufacturer or supplier warranty |
N1 | Group 1 Oxygen Coverage Criteria Met |
N2 | Group 2 Oxygen Coverage Criteria Met |
N3 | Group 3 Oxygen Coverage Criteria Met |
NU | New durable medical equipment purchase |
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 |
QA | Prescribed amounts of stationary oxygen for daytime use while at rest and nighttime use differ and the average of the two amounts is less than 1 liter per minute (LPM) |
QB | Prescribed amounts of stationary oxygen for daytime used while at rest and nighttime use differ and the average of the two amounts exceeds 4 liters per minute (LPM) and portable oxygen is prescribed |
QE | Prescribed amount of oxygen is less than 1 liter per minute (LPM) |
QF | Prescribed amount of oxygen exceeds 4 liters per minute and portable oxygen is prescribed |
QG | Prescribed amount of oxygen is greater than 4 liters per minute |
QH | Oxygen conserving device is being used with an oxygen delivery system |
QJ | Service/items provided to a prisoner or patient in state or local custody, however the state or local government, as applicable, meets the requirement in 42 CFR 411.1(B) |
Claim submitted with a written statement of intent | |
QR | Prescribed amounts of stationary oxygen for daytime use while at rest and nighttime use differ and the average of the two amounts is greater than 4 liters per minute (LPM) |
RA | Replacement of a DME, Orthotic or Prosthetic Item due to loss, stolen or irreparable damage |
RB | Replacement of a Part of a DME, Orthotic or Prosthetic Item Furnished as Part of a Repair |
RR | Rental (Use this ‘RR' modifier when DME is to be rented) |
RT | Right side (Used to identify procedures performed on the right side of the body) |
ST | Related to trauma or injury |
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 |
UE | Used durable medical equipment purchase |
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Last Updated Tue, 21 Feb 2023 20:16:20 +0000
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