A modifier provides the means by which the reporting physician or 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. The judicious application of modifiers obviates the necessity for separate procedure listings that may describe the modifying circumstance. Modifiers may be used to indicate to the recipient of a report that:
A service or procedure has both a professional and technical component.
A service or procedure was performed by more than one physician and/or in more than one location.
A service or procedure has been increased or reduced.
Only part of a service was performed.
An adjunctive service was performed.
A bilateral procedure was performed.
A service or procedure was provided more than once.
Unusual events occurred.
HCPCS modifier codes are divided into two levels, or groups, as described below:
Level I
Codes and descriptors copyrighted by the American Medical Association's current procedural terminology, fourth edition (CPT-4). These are 2 position numeric codes.
**** NOTE: ****
CPT-4 codes including long, short and consumer friendly descriptions shall be used in accordance with the CMS/AMA agreement. Any other use violates the AMA copyright.
Level II
Codes and descriptors approved and maintained jointly by the alpha-numeric editorial panel (consisting of CMS, the Health Insurance Association of America, and the Blue Cross and Blue Shield Association). These are 2 position alpha-numeric codes.
Code | Short Description | Long Description |
---|---|---|
A1 | Dressing for one wound | Dressing for one wound |
A2 | Dressing for two wounds | Dressing for two wounds |
A3 | Dressing for three wounds | Dressing for three wounds |
A4 | Dressing for four wounds | Dressing for four wounds |
A5 | Dressing for five wounds | Dressing for five wounds |
A6 | Dressing for six wounds | Dressing for six wounds |
A7 | Dressing for seven wounds | Dressing for seven wounds |
A8 | Dressing for eight wounds | Dressing for eight wounds |
A9 | Dressing for 9 or more wound | Dressing for nine or more wounds |
AA | Anesthesia perf by anesgst | Anesthesia services performed personally by anesthesiologist |
AD | Md supervision, >4 anes proc | Medical supervision by a physician: more than four concurrent anesthesia procedures |
AE | Registered dietician | Registered dietician |
AF | Specialty physician | Specialty physician |
AG | Primary physician | Primary physician |
AH | Clinical psychologist | Clinical psychologist |
AI | Principal physician of rec | Principal physician of record |
AJ | Clinical social worker | Clinical social worker |
AK | Non participating physician | Non participating physician |
AM | Physician, team member svc | Physician, team member service |
AO | Prov declined alt pmt method | Alternate payment method declined by provider of service |
AP | No dtmn of refractive state | Determination of refractive state was not performed in the course of diagnostic ophthalmological examination |
AQ | Physician service hpsa area | Physician providing a service in an unlisted health professional shortage area (hpsa) |
AR | Physician scarcity area | Physician provider services in a physician scarcity area |
AS | Assistant at surgery service | Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery |
AT | Acute treatment | Acute treatment (this modifier should be used when reporting service 98940, 98941, 98942) |
AU | Uro, ostomy or trach item | Item furnished in conjunction with a urological, ostomy, or tracheostomy supply |
AV | Item w prosthetic/orthotic | Item furnished in conjunction with a prosthetic device, prosthetic or orthotic |
AW | Item w a surgical dressing | Item furnished in conjunction with a surgical dressing |
AX | Item w dialysis services | Item furnished in conjunction with dialysis services |
AY | Item/service not for esrd tx | Item or service furnished to an esrd patient that is not for the treatment of esrd |
AZ | Physician serv in dent hpsa | Physician providing a service in a dental health professional shortage area for the purpose of an electronic health record incentive payment |
BA | Item w pen services | Item furnished in conjunction with parenteral enteral nutrition (pen) services |
BL | Spec acquisition blood prods | Special acquisition of blood and blood products |
BO | Nutrition oral admin no tube | Orally administered nutrition, not by feeding tube |
BP | Bene electd to purchase item | The beneficiary has been informed of the purchase and rental options and has elected to purchase the item |
BR | Bene elected to rent item | The beneficiary has been informed of the purchase and rental options and has elected to rent the item |
BU | Bene undecided on purch/rent | The beneficiary has been informed of the purchase and rental options and after 30 days has not informed the supplier of his/her decision |
CA | Procedure payable inpatient | Procedure payable only in the inpatient setting when performed emergently on an outpatient who expires prior to admission |
CB | Esrd bene part a snf-sep pay | Service ordered by a renal dialysis facility (rdf) physician as part of the esrd beneficiary's dialysis benefit, is not part of the composite rate, and is separately reimbursable |
CC | Procedure code change | Procedure code change (use 'cc' when the procedure code submitted was changed either for administrative reasons or because an incorrect code was filed) |
CD | Amcc test for esrd or mcp md | 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 | Med neces amcc tst sep reimb | Amcc test 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 tst not composite rate | Amcc test has been ordered by an esrd facility or mcp physician that is not part of the composite rate and is separately billable |
CG | Policy criteria applied | Policy criteria applied |
CH | 0 percent impaired, ltd, res | 0 percent impaired, limited or restricted |
CI | 1 to <20 percent impaired | At least 1 percent but less than 20 percent impaired, limited or restricted |
CJ | 20 to <40 percent impaired | At least 20 percent but less than 40 percent impaired, limited or restricted |
CK | 40 to <60 percent impaired | At least 40 percent but less than 60 percent impaired, limited or restricted |
CL | 60 to <80 percent impaired | At least 60 percent but less than 80 percent impaired, limited or restricted |
CM | 80 to <100 percent impaired | At least 80 percent but less than 100 percent impaired, limited or restricted |
CN | 100 percent impaired, ltd | 100 percent impaired, limited or restricted |
CO | Outpatient ot service by ota | Outpatient occupational therapy services furnished in whole or in part by an occupational therapy assistant |
CP | C-apc adjunctive service | Adjunctive service related to a procedure assigned to a comprehensive ambulatory payment classification (c-apc) procedure, but reported on a different claim |
CQ | Outpatient pt service by pta | Outpatient physical therapy services furnished in whole or in part by a physical therapist assistant |
CR | Catastrophe/disaster related | Catastrophe/disaster related |
CS | Gulf oil 2010 spill related | 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 |
CT | Ct does not meet nema standa | 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 |
DA | Oral health assess, not dent | Oral health assessment by a licensed health professional other than a dentist |
E1 | Upper left eyelid | Upper left, eyelid |
E2 | Lower left eyelid | Lower left, eyelid |
E3 | Upper right eyelid | Upper right, eyelid |
E4 | Lower right eyelid | Lower right, eyelid |
EA | Esa, anemia, chemo-induced | Erythropoetic stimulating agent (esa) administered to treat anemia due to anti-cancer chemotherapy |
EB | Esa, anemia, radio-induced | Erythropoetic stimulating agent (esa) administered to treat anemia due to anti-cancer radiotherapy |
EC | Esa, anemia, non-chemo/radio | Erythropoetic stimulating agent (esa) administered to treat anemia not due to anti-cancer radiotherapy or anti-cancer chemotherapy |
ED | Hct>39% or hgb>13g>=3 cycle | 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 | Hct>39% or hgb>13g<3 cycle | 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 |
EJ | Subsequent claim | Subsequent claims for a defined course of therapy, e.g., epo, sodium hyaluronate, infliximab |
EM | Emer reserve supply (esrd) | Emergency reserve supply (for esrd benefit only) |
EP | Medicaid epsdt program svc | Service provided as part of medicaid early periodic screening diagnosis and treatment (epsdt) program |
ER | Off-campus ed service | Items and services furnished by a provider-based, off-campus emergency department |
ET | Emergency services | Emergency services |
EX | Expatriate beneficiary | Expatriate beneficiary |
EY | No md order for item/service | No physician or other licensed health care provider order for this item or service |
F1 | Left hand, second digit | Left hand, second digit |
F2 | Left hand, third digit | Left hand, third digit |
F3 | Left hand, fourth digit | Left hand, fourth digit |
F4 | Left hand, fifth digit | Left hand, fifth digit |
F5 | Right hand, thumb | Right hand, thumb |
F6 | Right hand, second digit | Right hand, second digit |
F7 | Right hand, third digit | Right hand, third digit |
F8 | Right hand, fourth digit | Right hand, fourth digit |
F9 | Right hand, fifth digit | Right hand, fifth digit |
FA | Left hand, thumb | Left hand, thumb |
FB | Item provided without cost | Item provided without cost to provider, supplier or practitioner, or full credit received for replaced device (examples, but not limited to, covered under warranty, replaced due to defect, free samples) |
FC | Part credit, replaced device | Partial credit received for replaced device |
FP | Svc part of family plan pgm | Service provided as part of family planning program |
FX | X-ray taken using film | X-ray taken using film |
FY | Computed radiography x-ray | X-ray taken using computed radiography technology/cassette-based imaging |
G0 | Telestroke | Telehealth services for diagnosis, evaluation, or treatment, of symptoms of an acute stroke |
G1 | Urr reading of less than 60 | Most recent urr reading of less than 60 |
G2 | Urr reading of 60 to 64.9 | Most recent urr reading of 60 to 64.9 |
G3 | Urr reading of 65 to 69.9 | Most recent urr reading of 65 to 69.9 |
G4 | Urr reading of 70 to 74.9 | Most recent urr reading of 70 to 74.9 |
G5 | Urr reading of 75 or greater | Most recent urr reading of 75 or greater |
G6 | Esrd patient <6 dialysis/mth | Esrd patient for whom less than six dialysis sessions have been provided in a month |
G7 | Payment limits do not apply | Pregnancy resulted from rape or incest or pregnancy certified by physician as life threatening |
G8 | Monitored anesthesia care | Monitored anesthesia care (mac) for deep complex, complicated, or markedly invasive surgical procedure |
G9 | Mac for at risk patient | Monitored anesthesia care for patient who has history of severe cardio-pulmonary condition |
GA | Liability waiver ind case | Waiver of liability statement issued as required by payer policy, individual case |
GB | Claim resubmitted | Claim being re-submitted for payment because it is no longer covered under a global payment demonstration |
GC | Resident/teaching phys serv | This service has been performed in part by a resident under the direction of a teaching physician |
GD | Unit of service > mue value | Units of service exceeds medically unlikely edit value and represents reasonable and necessary services |
GE | Resident prim care exception | This service has been performed by a resident without the presence of a teaching physician under the primary care exception |
GF | Nonphysician serv c a hosp | Non-physician (e.g. nurse practitioner (np), certified registered nurse anesthetist (crna), certified registered nurse (crn), clinical nurse specialist (cns), physician assistant (pa)) services in a critical access hospital |
GG | Payment screen mam + diagmam | Performance and payment of a screening mammogram and diagnostic mammogram on the same patient, same day |
GH | Diag mammo to screening mamo | Diagnostic mammogram converted from screening mammogram on same day |
GJ | Opt out provider of er srvc | "opt out"" physician or practitioner emergency or urgent service" |
GK | Actual item/service ordered | Reasonable and necessary item/service associated with a ga or gz modifier |
GL | Upgraded item, no charge | Medically unnecessary upgrade provided instead of non-upgraded item, no charge, no advance beneficiary notice (abn) |
GM | Multiple transports | Multiple patients on one ambulance trip |
GN | Op speech language service | Services delivered under an outpatient speech language pathology plan of care |
GO | Op occupational therapy serv | Services delivered under an outpatient occupational therapy plan of care |
GP | Op pt services | Services delivered under an outpatient physical therapy plan of care |
GQ | Telehealth store and forward | Via asynchronous telecommunications system |
GR | Service by va resident | 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 | Epo/darbepoietin reduced 25% | Dosage of erythropoietin stimulating agent has been reduced and maintained in response to hematocrit or hemoglobin level |
GT | Interactivetelecommunication | Via interactive audio and video telecommunication systems |
GU | Liability waiver rout notice | Waiver of liability statement issued as required by payer policy, routine notice |
GV | Attending phys not hospice | Attending physician not employed or paid under arrangement by the patient's hospice provider |
GW | Service unrelated to term co | Service not related to the hospice patient's terminal condition |
GX | Voluntary liability notice | Notice of liability issued, voluntary under payer policy |
GY | Statutorily excluded | Item or service statutorily excluded, does not meet the definition of any medicare benefit or, for non-medicare insurers, is not a contract benefit |
GZ | Not reasonable and necessary | Item or service expected to be denied as not reasonable and necessary |
H9 | Court-ordered | Court-ordered |
HA | Child/adolescent program | Child/adolescent program |
HB | Adult program non-geriatric | Adult program, non geriatric |
HC | Adult program geriatric | Adult program, geriatric |
HD | Pregnant/parenting program | Pregnant/parenting women's program |
HE | Mental health program | Mental health program |
HF | Substance abuse program | Substance abuse program |
HG | Opioid addiction tx program | Opioid addiction treatment program |
HH | Mental hlth/substance abs pr | Integrated mental health/substance abuse program |
HI | Men hlth intel/dev disab pgm | Integrated mental health and intellectual disability/developmental disabilities program |
HJ | Employee assistance program | Employee assistance program |
HK | Spec hgh rsk mntl hlth pop p | Specialized mental health programs for high-risk populations |
HL | Intern | Intern |
HM | Less than bachelor degree lv | Less than bachelor degree level |
HN | Bachelors degree level | Bachelors degree level |
HO | Masters degree level | Masters degree level |
HP | Doctoral level | Doctoral level |
HQ | Group setting | Group setting |
HR | Family/couple w client prsnt | Family/couple with client present |
HS | Family/couple w/o client prs | Family/couple without client present |
HT | Multi-disciplinary team | Multi-disciplinary team |
HU | Child welfare agency funded | Funded by child welfare agency |
HV | Funded state addiction agncy | Funded state addictions agency |
HW | State mntl hlth agncy funded | Funded by state mental health agency |
HX | County/local agency funded | Funded by county/local agency |
HY | Funded by juvenile justice | Funded by juvenile justice agency |
HZ | Criminal justice agncy fund | Funded by criminal justice agency |
J1 | Cap no-pay for prescript num | Competitive acquisition program no-pay submission for a prescription number |
J2 | Cap restock of emerg drugs | Competitive acquisition program, restocking of emergency drugs after emergency administration |
J3 | Cap drug unavail thru cap | Competitive acquisition program (cap), drug not available through cap as written, reimbursed under average sales price methodology |
J4 | Dmepos comp bid furn by hosp | Dmepos item subject to dmepos competitive bidding program that is furnished by a hospital upon discharge |
JA | Administered intravenously | Administered intravenously |
JB | Administered subcutaneously | Administered subcutaneously |
JC | Skin substitute graft | Skin substitute used as a graft |
JD | Skin sub not used as a graft | Skin substitute not used as a graft |
JE | Administered via dialysate | Administered via dialysate |
JF | Compounded drug | Compounded drug |
JG | 340b acquired drug | Drug or biological acquired with 340b drug pricing program discount |
JW | Discarded drug not administe | Drug amount discarded/not administered to any patient |
K0 | Lwr ext prost functnl lvl 0 | 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 | Lwr ext prost functnl lvl 1 | 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 ambulator. |
K2 | Lwr ext prost functnl lvl 2 | 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 | Lwr ext prost functnl lvl 3 | 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 | Lwr ext prost functnl lvl 4 | Lower extremity 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. |
KA | Wheelchair add-on option/acc | Add on option/accessory for wheelchair |
KB | >4 modifiers on claim | Beneficiary requested upgrade for abn, more than 4 modifiers identified on claim |
KC | Repl special pwr wc intrface | Replacement of special power wheelchair interface |
KD | Drug/biological dme infused | Drug or biological infused through dme |
KE | Bid under round 1 dmepos cb | Bid under round one of the dmepos competitive bidding program for use with non-competitive bid base equipment |
KF | Fda class iii device | Item designated by fda as class iii device |
KG | Dmepos comp bid prgm no 1 | Dmepos item subject to dmepos competitive bidding program number 1 |
KH | Dmepos ini clm, pur/1 mo rnt | Dmepos item, initial claim, purchase or first month rental |
KI | Dmepos 2nd or 3rd mo rental | Dmepos item, second or third month rental |
KJ | Dmepos pen pmp or 4-15mo rnt | Dmepos item, parenteral enteral nutrition (pen) pump or capped rental, months four to fifteen |
KK | Dmepos comp bid prgm no 2 | Dmepos item subject to dmepos competitive bidding program number 2 |
KL | Dmepos mailorder comp bid | Dmepos item delivered via mail |
KM | Rplc facial prosth new imp | Replacement of facial prosthesis including new impression/moulage |
KN | Rplc facial prosth old mod | Replacement of facial prosthesis using previous master model |
KO | Single drug unit dose form | Single drug unit dose formulation |
KP | First drug of multi drug u d | First drug of a multiple drug unit dose formulation |
KQ | 2nd/subsqnt drg multi drg ud | Second or subsequent drug of a multiple drug unit dose formulation |
KR | Rental item partial month | Rental item, billing for partial month |
KS | Glucose monitor supply | Glucose monitor supply for diabetic beneficiary not treated with insulin |
KT | Item from noncontract supply | Beneficiary resides in a competitive bidding area and travels outside that competitive bidding area and receives a competitive bid item |
KU | Dmepos comp bid prgm no 3 | Dmepos item subject to dmepos competitive bidding program number 3 |
KV | Dmepos item, profession serv | Dmepos item subject to dmepos competitive bidding program that is furnished as part of a professional service |
KW | Dmepos comp bid prgm no 4 | Dmepos item subject to dmepos competitive bidding program number 4 |
KX | Documentation on file | Requirements specified in the medical policy have been met |
KY | Dmepos comp bid prgm no 5 | Dmepos item subject to dmepos competitive bidding program number 5 |
KZ | New cov not implement by m+c | New coverage not implemented by managed care |
L1 | Separately payable lab test | Provider attestation that the hospital laboratory test(s) is not packaged under the hospital opps |
LC | Lft circum coronary artery | Left circumflex coronary artery |
LD | Left ant des coronary artery | Left anterior descending coronary artery |
LL | Lease/rental (appld to pur) | Lease/rental (use the 'll' modifier when dme equipment rental is to be applied against the purchase price) |
LM | Left main coronary artery | Left main coronary artery |
LR | Laboratory round trip | Laboratory round trip |
LS | Fda-monitored iol implant | Fda-monitored intraocular lens implant |
LT | Left side | Left side (used to identify procedures performed on the left side of the body) |
M2 | Medicare secondary payer | Medicare secondary payer (msp) |
MA | Emer med cond susp/confirm | Ordering professional is not required to consult a clinical decision support mechanism due to service being rendered to a patient with a suspected or confirmed emergency medical condition |
MB | Auc hardship, insuf internet | Ordering professional is not required to consult a clinical decision support mechanism due to the significant hardship exception of insufficient internet access |
MC | Auc hardship, vendor issues | Ordering professional is not required to consult a clinical decision support mechanism due to the significant hardship exception of electronic health record or clinical decision support mechanism vendor issues |
MD | Auc hardship, extreme circ | Ordering professional is not required to consult a clinical decision support mechanism due to the significant hardship exception of extreme and uncontrollable circumstances |
ME | Order adheres to auc | The order for this service adheres to appropriate use criteria in the clinical decision support mechanism consulted by the ordering professional |
MF | Order does not adhere to auc | The order for this service does not adhere to the appropriate use criteria in the clinical decision support mechanism consulted by the ordering professional |
MG | Auc not applicable to order | The order for this service does not have applicable appropriate use criteria in the qualified clinical decision support mechanism consulted by the ordering professional |
MH | Auc consult not provided | Unknown if ordering professional consulted a clinical decision support mechanism for this service, related information was not provided to the furnishing professional or provider |
MS | 6-mo maint/svc fee parts/lbr | Six month maintenance and servicing fee for reasonable and necessary parts and labor which are not covered under any manufacturer or supplier warranty |
NB | Drug specific nebulizer | Nebulizer system, any type, fda-cleared for use with specific drug |
NR | New when rented | New when rented (use the 'nr' modifier when dme which was new at the time of rental is subsequently purchased) |
NU | New equipment | New equipment |
P1 | Normal healthy patient | A normal healthy patient |
P2 | Patient w/mild syst disease | A patient with mild systemic disease |
P3 | Patient w/severe sys disease | A patient with severe systemic disease |
P4 | Pt w/sev sys dis threat life | A patient with severe systemic disease that is a constant threat to life |
P5 | Pt not expect surv w/o oper | A moribund patient who is not expected to survive without the operation |
P6 | Brain-dead pt organs removed | A declared brain-dead patient whose organs are being removed for donor purposes |
PA | Surgery, wrong body part | Surgical or other invasive procedure on wrong body part |
PB | Surgery, wrong patient | Surgical or other invasive procedure on wrong patient |
PC | Wrong surgery on patient | Wrong surgery or other invasive procedure on patient |
PD | Inp admit w/in 3 days | Diagnostic or related non diagnostic item or service provided in a wholly owned or operated entity to a patient who is admitted as an inpatient within 3 days |
PI | Pet tumor init tx strat | Positron emission tomography (pet) or pet/computed tomography (ct) to inform the initial treatment strategy of tumors that are biopsy proven or strongly suspected of being cancerous based on other diagnostic testing |
PL | Progressive addition lenses | Progressive addition lenses |
PM | Post mortem | Post mortem |
PN | Non-excepted off-campus svc | Non-excepted service provided at an off-campus, outpatient, provider-based department of a hospital |
PO | Excepted off-campus service | Excepted service provided at an off-campus, outpatient, provider-based department of a hospital |
PS | Pet tumor subsq tx strategy | Positron emission tomography (pet) or pet/computed tomography (ct) to inform the subsequent treatment strategy of cancerous tumors when the beneficiary's treating physician determines that the pet study is needed to inform subsequent anti-tumor strategy |
PT | Clrctal screen to diagn | Colorectal cancer screening test; converted to diagnostic test or other procedure |
Q0 | Invest clinical research | Investigational clinical service provided in a clinical research study that is in an approved clinical research study |
Q1 | Routine clinical research | Routine clinical service provided in a clinical research study that is in an approved clinical research study |
Q2 | Demo procedure, service | Demonstration procedure/service |
Q3 | Live donor surgery/services | Live kidney donor surgery and related services |
Q4 | Svc exempt - ordrg/rfrng md | Service for ordering/referring physician qualifies as a service exemption |
Q5 | Recip bill arr subs md or pt | Service furnished under a reciprocal billing arrangement by a substitute physician or by a substitute physical therapist furnishing outpatient physical therapy services in a health professional shortage area, a medically underserved area, or a rural area |
Q6 | Fee/time comp subst md or pt | Service furnished under a fee-for-time compensation arrangement by a substitute physician or by a substitute physical therapist furnishing outpatient physical therapy services in a health professional shortage area, a medically underserved area, or a rural area |
Q7 | One class a finding | One class a finding |
Q8 | Two class b findings | Two class b findings |
Q9 | 1 class b & 2 class c fndngs | One class b and two class c findings |
QA | Avg sta day/night o2 < 1 lpm | 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 | Avg day/nite o2 > 4 lpm/port | Prescribed amounts of stationary oxygen for daytime use 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 |
QC | Single channel monitoring | Single channel monitoring |
QD | Rcrdg/strg in sld st memory | Recording and storage in solid state memory by a digital recorder |
QE | Stationary o2 @ rest <1 lpm | Prescribed amount of stationary oxygen while at rest is less than 1 liter per minute (lpm) |
QF | Station o2 @ rest >4lpm/port | Prescribed amount of stationary oxygen while at rest exceeds 4 liters per minute (lpm) and portable oxygen is prescribed |
QG | Station o2 @ rest > 4 lpm | Prescribed amount of stationary oxygen while at rest is greater than 4 liters per minute (lpm) |
QH | Oxygen cnsrvg dvc w del sys | Oxygen conserving device is being used with an oxygen delivery system |
QJ | Patient in state/locl custod | 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 | Med dir 2-4 cncrnt anes proc | Medical direction of two, three, or four concurrent anesthesia procedures involving qualified individuals |
QL | Patient died after amb call | Patient pronounced dead after ambulance called |
QM | Ambulance arr by provider | Ambulance service provided under arrangement by a provider of services |
QN | Ambulance furn by provider | Ambulance service furnished directly by a provider of services |
QP | Individually ordered lab tst | 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 80002-80019, g0058, g0059, and g0060. |
Qualified cdsm consulted | Ordering professional consulted a qualified clinical decision support mechanism for this service and the related data was provided to the furnishing professional | |
QR | Avg sta day/night o2 > 4 lpm | 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) |
QS | Monitored anesthesia care | Monitored anesthesia care service |
QT | Rcrdg/strg tape analog recdr | Recording and storage on tape by an analog tape recorder |
QW | Clia waived test | Clia waived test |
QX | Crna svc w/ md med direction | Crna service: with medical direction by a physician |
QY | Medically directed crna | Medical direction of one certified registered nurse anesthetist (crna) by an anesthesiologist |
QZ | Crna svc w/o med dir by md | Crna service: without medical direction by a physician |
RA | Replacement of dme item | Replacement of a dme, orthotic or prosthetic item |
RB | Replacement part, dme item | Replacement of a part of a dme, orthotic or prosthetic item furnished as part of a repair |
RC | Right coronary artery | Right coronary artery |
RD | Drug admin not incident-to | Drug provided to beneficiary, but not administered "incident-to""" |
RE | Furnish full compliance rems | Furnished in full compliance with fda-mandated risk evaluation and mitigation strategy (rems) |
RI | Ramus intermedius cor artery | Ramus intermedius coronary artery |
RR | Rental (dme) | Rental (use the 'rr' modifier when dme is to be rented) |
RT | Right side | Right side (used to identify procedures performed on the right side of the body) |
SA | Nurse practitioner w physici | Nurse practitioner rendering service in collaboration with a physician |
SB | Nurse midwife | Nurse midwife |
SC | Medically necessary serv/sup | Medically necessary service or supply |
SD | Serv by home infusion rn | Services provided by registered nurse with specialized, highly technical home infusion training |
SE | State/fed funded program/ser | State and/or federally-funded programs/services |
SF | 2nd opinion ordered by pro | Second opinion ordered by a professional review organization (pro) per section 9401, p.l. 99-272 (100% reimbursement - no medicare deductible or coinsurance) |
SG | Asc facility service | Ambulatory surgical center (asc) facility service |
SH | 2nd concurrent infusion ther | Second concurrently administered infusion therapy |
SJ | 3rd concurrent infusion ther | Third or more concurrently administered infusion therapy |
SK | High risk population | Member of high risk population (use only with codes for immunization) |
SL | State supplied vaccine | State supplied vaccine |
SM | Second opinion | Second surgical opinion |
SN | Third opinion | Third surgical opinion |
SQ | Item ordered by home health | Item ordered by home health |
SS | Hit in infusion suite | Home infusion services provided in the infusion suite of the iv therapy provider |
ST | Related to trauma or injury | Related to trauma or injury |
SU | Performed in phys office | Procedure performed in physician's office (to denote use of facility and equipment) |
SV | Drugs delivered not used | Pharmaceuticals delivered to patient's home but not utilized |
SW | Serv by cert diab educator | Services provided by a certified diabetic educator |
SY | Contact w/high-risk pop | Persons who are in close contact with member of high-risk population (use only with codes for immunization) |
SZ | Habilitative services | Habilitative services |
T1 | Left foot, second digit | Left foot, second digit |
T2 | Left foot, third digit | Left foot, third digit |
T3 | Left foot, fourth digit | Left foot, fourth digit |
T4 | Left foot, fifth digit | Left foot, fifth digit |
T5 | Right foot, great toe | Right foot, great toe |
T6 | Right foot, second digit | Right foot, second digit |
T7 | Right foot, third digit | Right foot, third digit |
T8 | Right foot, fourth digit | Right foot, fourth digit |
T9 | Right foot, fifth digit | Right foot, fifth digit |
TA | Left foot, great toe | Left foot, great toe |
TB | Tracking 340b acquired drug | Drug or biological acquired with 340b drug pricing program discount, reported for informational purposes |
TC | Technical component | Technical component; under certain circumstances, a charge may be made for the technical component alone; under those circumstances the technical component charge is identified by adding modifier 'tc' to the usual procedure number; technical component charges are institutional charges and not billed separately by physicians; however, portable x-ray suppliers only bill for technical component and should utilize modifier tc; the charge data from portable x-ray suppliers will then be used to build customary and prevailing profiles |
TD | Rn | Rn |
TE | Lpn/lvn | Lpn/lvn |
TF | Intermediate level of care | Intermediate level of care |
TG | Complex/high tech level care | Complex/high tech level of care |
TH | Ob tx/srvcs prenatl/postpart | Obstetrical treatment/services, prenatal or postpartum |
TJ | Child/adolescent program gp | Program group, child and/or adolescent |
TK | Extra patient or passenger | Extra patient or passenger, non-ambulance |
TL | Early intervention ifsp | Early intervention/individualized family service plan (ifsp) |
TM | Individualized ed prgrm(iep) | Individualized education program (iep) |
TN | Rural/out of service area | Rural/outside providers' customary service area |
TP | Med transprt unloaded vehicl | Medical transport, unloaded vehicle |
TQ | Bls by volunteer amb providr | Basic life support transport by a volunteer ambulance provider |
TR | School-based iep out of dist | School-based individualized education program (iep) services provided outside the public school district responsible for the student |
TS | Follow-up service | Follow-up service |
TT | Additional patient | Individualized service provided to more than one patient in same setting |
TU | Overtime payment rate | Special payment rate, overtime |
TV | Holiday/weekend payment rate | Special payment rates, holidays/weekends |
TW | Back-up equipment | Back-up equipment |
U1 | M/caid care lev 1 state def | Medicaid level of care 1, as defined by each state |
U2 | M/caid care lev 2 state def | Medicaid level of care 2, as defined by each state |
U3 | M/caid care lev 3 state def | Medicaid level of care 3, as defined by each state |
U4 | M/caid care lev 4 state def | Medicaid level of care 4, as defined by each state |
U5 | M/caid care lev 5 state def | Medicaid level of care 5, as defined by each state |
U6 | M/caid care lev 6 state def | Medicaid level of care 6, as defined by each state |
U7 | M/caid care lev 7 state def | Medicaid level of care 7, as defined by each state |
U8 | M/caid care lev 8 state def | Medicaid level of care 8, as defined by each state |
U9 | M/caid care lev 9 state def | Medicaid level of care 9, as defined by each state |
UA | M/caid care lev 10 state def | Medicaid level of care 10, as defined by each state |
UB | M/caid care lev 11 state def | Medicaid level of care 11, as defined by each state |
UC | M/caid care lev 12 state def | Medicaid level of care 12, as defined by each state |
UD | M/caid care lev 13 state def | Medicaid level of care 13, as defined by each state |
UE | Used durable med equipment | Used durable medical equipment |
UF | Services provided, morning | Services provided in the morning |
UG | Services provided, afternoon | Services provided in the afternoon |
UH | Services provided, evening | Services provided in the evening |
UJ | Services provided, night | Services provided at night |
UK | Svc on behalf client-collat | Services provided on behalf of the client to someone other than the client (collateral relationship) |
UN | Two patients served | Two patients served |
UP | Three patients served | Three patients served |
UQ | Four patients served | Four patients served |
UR | Five patients served | Five patients served |
US | Six or more patients served | Six or more patients served |
V1 | Demonstration modifier 1 | Demonstration modifier 1 |
V2 | Demonstration modifier 2 | Demonstration modifier 2 |
V3 | Demonstration modifier 3 | Demonstration modifier 3 |
V5 | Vascular catheter | Vascular catheter (alone or with any other vascular access) |
V6 | Arteriovenous graft | Arteriovenous graft (or other vascular access not including a vascular catheter) |
V7 | Arteriovenous fistula | Arteriovenous fistula only (in use with two needles) |
V8 | Infection present | Infection present |
V9 | No infection present | No infection present |
VM | Mdpp virtual make-up session | Medicare diabetes prevention program (mdpp) virtual make-up session |
VP | Aphakic patient | Aphakic patient |
X1 | Continuous/broad services | Continuous/broad services: for reporting services by clinicians, who provide the principal care for a patient, with no planned endpoint of the relationship; services in this category represent comprehensive care, dealing with the entire scope of patient problems, either directly or in a care coordination role; reporting clinician service examples include, but are not limited to: primary care, and clinicians providing comprehensive care to patients in addition to specialty care |
X2 | Continuous/focused services | Continuous/focused services: for reporting services by clinicians whose expertise is needed for the ongoing management of a chronic disease or a condition that needs to be managed and followed with no planned endpoint to the relationship; reporting clinician service examples include but are not limited to: a rheumatologist taking care of the patient's rheumatoid arthritis longitudinally but not providing general primary care services |
X3 | Episodic/broad services | Episodic/broad servies: for reporting services by clinicians who have broad responsibility for the comprehensive needs of the patient that is limited to a defined period and circumstance such as a hospitalization; reporting clinician service examples include but are not limited to the hospitalist's services rendered providing comprehensive and general care to a patient while admitted to the hospital |
X4 | Episodic/focused services | Episodic/focused services: for reporting services by clinicians who provide focused care on particular types of treatment limited to a defined period and circumstance; the patient has a problem, acute or chronic, that will be treated with surgery, radiation, or some other type of generally time-limited intervention; reporting clinician service examples include but are not limited to, the orthopedic surgeon performing a knee replacement and seeing the patient through the postoperative period |
X5 | Svc req by another clinician | Diagnostic services requested by another clinician: for reporting services by a clinician who furnishes care to the patient only as requested by another clinician or subsequent and related services requested by another clinician; this modifier is reported for patient relationships that may not be adequately captured by the above alternative categories; reporting clinician service examples include but are not limited to, the radiologist's interpretation of an imaging study requested by another clinician |
XE | Separate encounter | Separate encounter, a service that is distinct because it occurred during a separate encounter |
XP | Separate practitioner | Separate practitioner, a service that is distinct because it was performed by a different practitioner |
XS | Separate organ/structure | Separate structure, a service that is distinct because it was performed on a separate organ/structure |
XU | Unusual separate service | Unusual non-overlapping service, the use of a service that is distinct because it does not overlap usual components of the main service |
ZA | Novartis/sandoz | Novartis/sandoz |
ZB | Pfizer/hospira | Pfizer/hospira |
ZC | Merck/samsung bioepis | Merck/samsung bioepis |