Skip over navigation

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.

X
 
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 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
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)
EY No physician or other licensed health care provider order for this item or service
GA Waiver of Liability statement on file
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 od 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 Advanced 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
JW 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
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
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)
QQ Claim submitted with a written statement of intent
RA Replacement of a DME, Orthotic or Prosthetic Item
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)
UE Used durable medical equipment purchase

Resource

Last Updated Jan 31, 2017