Modifiers

Modifiers can be two digit numbers, two character modifiers, or alpha-numeric indicators. Modifiers provide additional information to payers to make sure your provider gets paid correctly for services rendered.

If appropriate, more than one modifier may be used with a single procedure code; however, are not applicable for every category of the CPT codes. Some modifiers can only used with a particular category and some are not compatible with others.

Note: To search for a specific modifier, enter "Mod" and the applicable modifier (e.g. Mod KX).

X
 
Modifier Modifier Description
Mod 22 Increased Procedural Services (surgical/procedures codes only)
Mod 24 Unrelated evaluation and management service by the same physician during a postoperative period
Mod 25 Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service
Mod 26 Professional Component Only (separate from technical component)
Mod 50 Bilateral Procedure
Mod 51 Multiple procedures
Mod 52 Partially Reduced/Eliminated Services
Mod 53 Discontinued Procedure (professional services only)
Mod 54 Surgical Care Only
Mod 55 Postoperative Management Only
Mod 57 An evaluation and management (E/M) service that resulted in the initial decision to perform the surgery may be identified by adding modifier 57 to the appropriate level of E/M service.
Mod 58 Staged or Related Procedure or Service During Postoperative Period by Same Physician
Mod 59 Distinct Procedural Service
Mod 62 Co-Surgeons
Mod 66 Team Surgeons – Surgical Team
Mod 73 Prior Discontinued Ambulatory Surgical Center (ASC) or Outpatient Hospital
Mod 74 After Anesthesia Administration - Discontinued Ambulatory Surgical Center (ASC) or Outpatient Hospital
Mod 76 Repeat procedure by same physician
Mod 77 Repeat procedure by another physician
Mod 78 Return to Operating Room for related surgery during post op period
Mod 79 Unrelated procedure or service by same physician during postoperative period
Mod 90 Reference (Outside) Laboratory
Mod 91 Repeat Clinical Diagnostic Lab Test
Mod 99 Multiple Modifiers (same line, same code)
Mod AI Principal Physician of Record
Mod AY Item or service furnished to ESRD patient - not for ESRD treatment
Mod CR Catastrophe/Disaster
Mod CT Computed tomography services furnished using equipment that does not meet each of the attributes of the National Electrical Manufacturers Association (NEMA) XR-29-2013 standard
Mod FX X-ray taken using film
Mod FY X-ray taken using computed radiography
Mod GC Service has been performed in part by a resident under the direction of a teaching physician
Mod GJ Opt-out physicians billing on an emergency basis for non-contracted patients.
Mod GV Attending physician is not employed or paid under agreement by the patient's Hospice provider
Mod GW Condition not related to the patient's terminal condition
Mod JW Drug amount discarded/not administered to any patient
Mod Q1 Routine clinical service provided in a clinical research study that is in an approved clinical research study
Mod Q0 Investigational clinical service provided in a clinical research study that is in an approved clinical research study

 

Advance Beneficiary Notice of Noncoverage (ABN) Modifiers

Modifier Modifier Description
Mod GA Waiver of Liability Statement Issued as Required by Payer Policy. Used to report a required ABN was issued for a service and is on file. A copy of ABN does not have to be submitted by must be made available upon request
Mod GX Notice of Liability Issued, Voluntary Under Payer Policy. Used to report a voluntary ABN was issued for a service
Mod GY Notice of Liability Not Issued, Not Required Under Payer Policy. Used to report that an ABN was not issued because item or service is statutorily excluded or does not meet definition of any Medicare benefit
Mod GZ Item or Service Expected to Be Denied as Not Reasonable and Necessary. Used to report an ABN was not issued for a service

 

Ambulance Origin/Destination Modifiers

Modifier Modifier Description
Mod D Diagnostic or therapeutic site other than 'P' or 'H' when these codes are used as origin codes. This modifier is to be used for transports to or from an Ambulatory surgical center (ASC) or a free-standing psychiatric facility.
Mod E Residential, domiciliary, custodial facility (other than an 1819 facility)
Mod G Hospital-based dialysis facility (hospital or hospital-related)
Mod GM Multiple patients on one ambulance trip. Note: Providers need to submit the appropriate origin and destination modifiers in the first modifier position and HCPCS modifier GM in the second modifier position.
Mod H Hospital. This modifier must be submitted for a psychiatric facility located at a hospital.
Mod I Site of transfer (e.g., airport or helicopter pad) between types of ambulance vehicles
Mod J Non hospital-based dialysis facility
Mod N Skilled nursing facility (SNF) (1819 Facility)
Mod P Physician's office (includes HMO non-hospital facility, clinic, etc.) For Medicare purposes, urgent care centers, clinics and freestanding emergency rooms are considered physician offices.
Mod QL Patient pronounced dead after ambulance called
Mod R Residence
Mod S Scene of accident or acute event
Mod X (Destination code only) Intermediate stop at physician's office on the way to the Hospital (includes HMO non-hospital facility, clinic, etc.)

Auto Denied Modifiers - DD, DE, DP, DR, DS, ED, EE, EP, ER, ES, GD, GG, GI, GJ, GP, GS, GX, HD, HG, HP, HS, HX, ID, IE, IJ, IN, IP, IR, IS, IX, JD, JG, JI, JJ, JP, JS, JX, NI, NN, NP, NS, PD, PE, PG, PJ, PN, PP, PR, PS, PX, RD, RE, RP, RR, RS, SD, SE, SG, SJ, SN, SP, SR, SS, XD, XE, XG, XJ, XN, XP, XR, XS, XX

Trips with one of these origin/destination modifiers are not covered and should not be submitted to Medicare. A provider may bill the patient directly for these services. If a provider must bill Medicare for a denial, append modifier GY.

Anatomic Modifiers

Append to a service that is performed on the hands, feet, eyelids, coronary artery or left and right side of the body.

Side of Body Modifiers

Modifier Modifier Description Modifier Modifier Description
Mod LT Left side of body Mod RT Right side of body

 

Eyelid Modifiers

Modifier Modifier Description Modifier Modifier Description
Mod E1 Upper left, eyelid Mod E3 Upper right, eyelid
Mod E2 Lower left, eyelid Mod E4 Lower right, eyelid

 

Hand Modifiers

Modifier Modifier Description Modifier Modifier Description
Mod FA Left hand, thumb Mod F5 Right hand, thumb
Mod F1 Left hand, second digit Mod F6 Right hand, second digit
Mod F2 Left hand, third digit Mod F7 Right hand, third digit
Mod F3 Left hand, fourth digit Mod F8 Right hand, fourth digit
Mod F4 Left hand, fifth digit Mod F9 Right hand, fifth digit

 

Feet Modifiers

Modifier Modifier Description Modifier Modifier Description
Mod TA Left foot, great toe Mod T5 Right foot, great toe
Mod T1 Left foot, second digit Mod T6 Right foot, second digit
Mod T2 Left foot, third digit Mod T7 Right foot, third digit
Mod T3 Left foot, fourth digit Mod T8 Right foot, fourth digit
Mod T4 Left foot, fifth digit Mod T9 Right foot, fifth digit

 

Coronary Artery Modifiers

Modifier Modifier Description Modifier Modifier Description
Mod LC Left circumflex coronary artery Mod RC Right coronary artery
Mod LD Left anterior descending coronary artery Mod LM Left main coronary artery
Mod RI Ramus Intermedius    

 

Anesthesia Modifiers

Anesthesia modifiers are used to receive the correct payment of anesthesia services. Pricing modifiers must be placed in the first modifier field to ensure proper payment (AA, AD, QK, QX, QY, and QZ). Informational modifiers are used in conjunction with pricing modifiers and must be placed in the second modifier position (QS, G8, G9, and 23).

Modifier Modifier Description
Mod AA Anesthesia services performed personally by an anesthesiologist
Mod AD Medical supervision by a physician; more than four concurrent anesthesia procedures
Mod G8 Monitored anesthesia care (MAC) for deep complex, complicated or markedly invasive surgical procedure
Mod G9 Monitored anesthesia care (MAC) for a patient who has a history of severe cardiopulmonary condition
Mod QK Medical direction of two, three or four concurrent anesthesia procedures involving qualified individuals
Mod QS Monitored anesthesia care service
Mod QX CRNA service; with medical direction by a physician
Mod QY Medical direction of one certified registered nurse anesthetist (CRNA) by an anesthesiologist
Mod QZ CRNA service; without medical direction by a physician
Mod 23 Unusual anesthesia - Used to report a procedure which usually requires either no anesthesia or local anesthesia; however, because of unusual circumstances must be done under general anesthesia. Coverage/payment will be determined on a "by-report" basis.
Mod 47 Anesthesia by surgeon – Used to report regional or general anesthesia provided by the surgeon (Not covered by Medicare).
P1 – P6 mod P1 mod P2 mod P3 mod P4 mod P5 mod P6 Physical Status Modifiers (Not used by Medicare)

 

Assist At Surgery Modifiers

Assistant at surgery services are those services rendered by physicians or non-physician practitioners who actively assist the physician in charge of performing a surgical procedure.

Modifier Modifier Description
Mod 80 Assistant surgeon
Mod 81 Minimum assistant surgeon
Mod 82 Assistant surgeon – when qualified resident surgeon not available
Mod AS Physician Assistant (PA), Nurse Practitioner (NP) or Clinical Nurse Specialist (CNS) assistant at surgery services

 

Chiropractic Modifier

Modifier Modifier Description
Mod AT Acute or Active Treatment

 

Physician Quality Reporting System (PQRS) Modifiers

Performance measure modifiers are used to indicate to special circumstances of a patient's encounter with the physician.

Modifier Modifier Description
Mod 1P Performance Measure Exclusion Modifier due to Medical Reasons
Mod 2P Performance Measure Exclusion Modifier due to Patient Reasons
Mod 3P Performance Measure Exclusion Modifier due to System Reasons
Mod 8P Performance Measure Reporting Modifier – action not performed, reason not otherwise specified

 

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 Modifier Description
Mod GN Services delivered under an outpatient speech language pathology plan of care
Mod GO Services delivered under an outpatient occupational therapy plan of care
Mod GP Services delivered under an outpatient physical therapy plan of care
Mod 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
Mod CH 0 percent impaired, limited or restricted
Mod CI At least 1 percent but less than 20 percent impaired, limited or restricted
Mod CJ At least 1 percent but less than 20 percent impaired, limited or restricted
Mod CK At least 40 percent but less than 60 percent impaired, limited or restricted
Mod CL At least 60 percent but less than 80 percent impaired, limited or restricted
Mod CM At least 80 percent but less than 100 percent impaired, limited or restricted
Mod CN 100 percent impaired, limited or restricted

 

Last Updated May 17, 2018