Modifier Codes

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.
QQ 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