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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.

NOTE: 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.

X
 
Modifier Modifier Description
22 Increased Procedural Services (surgical/procedures codes only)
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 Only (separate from technical component)
50 Bilateral Procedure
51 Multiple procedures
52 Partially Reduced/Eliminated Services
53 Discontinued Procedure (professional services only)
54 Surgical Care Only
55 Postoperative Management Only
58 Staged or Related Procedure or Service During Postoperative Period by Same Physician
59 Distinct Procedural Service
62 Co-Surgeons
66 Team Surgeons – Surgical Team
73 Prior Discontinued Ambulatory Surgical Center (ASC) or Outpatient Hospital
74 After Anesthesia Administration - Discontinued Ambulatory Surgical Center (ASC) or Outpatient Hospital
76 Repeat procedure by same physician
77 Repeat procedure by another physician
78 Return to Operating Room for related surgery during post op period
79 Unrelated procedure or service by same physician during postoperative period
90 Reference (Outside) Laboratory
91 Repeat Clinical Diagnostic Lab Test
99 Multiple Modifiers (same line, same code)
AI Principal Physician of Record
AY Item or service furnished to ESRD patient - not for ESRD treatment
GC Service has been performed in part by a resident under the direction of a teaching physician
GJ Opt-out physicians billing on an emergency basis for non-contracted patients.
GV Attending physician is not employed or paid under agreement by the patient's Hospice provider
GW Condition not related to the patient's terminal condition
JW Drug amount discarded/not administered to any patient
Q1 Routine clinical service provided in a clinical research study that is in an approved clinical research study
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
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
GX Notice of Liability Issued, Voluntary Under Payer Policy. Used to report a voluntary ABN was issued for a service
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
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
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.
E Residential, domiciliary, custodial facility (other than an 1819 facility)
G Hospital-based dialysis facility (hospital or hospital-related)
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.
H Hospital. This modifier must be submitted for a psychiatric facility located at a hospital.
I Site of transfer (e.g., airport or helicopter pad) between types of ambulance vehicles
J Non hospital-based dialysis facility
N Skilled nursing facility (SNF) (1819 Facility)
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.
QL Patient pronounced dead after ambulance called
R Residence
S Scene of accident or acute event
X (Destination code only) Intermediate stop at physician's office on the way to the Hospital (includes HMO non-hospital facility, clinic, etc.)

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
LT Left side of body RT Right side of body

Eyelid Modifiers

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

Hand Modifiers

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

Feet Modifiers

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

Coronary Artery Modifiers

Modifier Modifier Description Modifier Modifier Description
LC Left circumflex coronary artery RC Right coronary artery
LD Left anterior descending coronary artery LM Left main coronary artery

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
AA Anesthesia services performed personally by an anesthesiologist
AD Medical supervision by a physician; more than four concurrent anesthesia procedures
G8 Monitored anesthesia care (MAC) for deep complex, complicated or markedly invasive surgical procedure
G9 Monitored anesthesia care (MAC) for a patient who has a history of severe cardiopulmonary condition
QK Medical direction of two, three or four concurrent anesthesia procedures involving qualified individuals
QS Monitored anesthesia care service
QX CRNA service; with medical direction by a physician
QY Medical direction of one certified registered nurse anesthetist (CRNA) by an anesthesiologist
QZ CRNA service; without medical direction by a physician
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.
47 Anesthesia by surgeon – Used to report regional or general anesthesia provided by the surgeon (Not covered by Medicare).
P1 – 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
80 Assistant surgeon
81 Minimum assistant surgeon
82 Assistant surgeon – when qualified resident surgeon not available
AS Physician Assistant (PA), Nurse Practitioner (NP) or Clinical Nurse Specialist (CNS) assistant at surgery services

Chiropractic Modifier

Modifier Modifier Description
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
1P Performance Measure Exclusion Modifier due to Medical Reasons
2P Performance Measure Exclusion Modifier due to Patient Reasons
3P Performance Measure Exclusion Modifier due to System Reasons
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
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

Last Updated Dec 16, 2016