Modifiers
Medical billing modifiers
384 HCPCS Level II modifiers from the CMS file dated September 23, 2026, and 39 common CPT modifiers in plain English.
Source: CMS HCPCS Level II, October 2026 file dated September 23, 2026. Publisher page
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Most searched modifiers
- 25Significant, separate E/M visit on the same day
- 59Distinct procedural service
- 95Synchronous telemedicine (audio and video)
- 26Professional component
- GTVia interactive audio and video telecommunication systems
- TCTechnical 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
- XUUnusual non-overlapping service, the use of a service that is distinct because it does not overlap usual components of the main service
- GAWaiver of liability statement issued as required by payer policy, individual case
- KXRequirements specified in the medical policy have been met
- XSSeparate structure, a service that is distinct because it was performed on a separate organ/structure
- 24Unrelated E/M visit in the postoperative period
- 50Bilateral procedure
- GYItem or service statutorily excluded, does not meet the definition of any medicare benefit or, for non-medicare insurers, is not a contract benefit
- GZItem or service expected to be denied as not reasonable and necessary
- JWDrug amount discarded/not administered to any patient
- LTLeft side (used to identify procedures performed on the left side of the body)
- RTRight side (used to identify procedures performed on the right side of the body)
- 51Multiple procedures
- GPServices delivered under an outpatient physical therapy plan of care
- JZZero drug amount discarded/not administered to any patient
- QWCLIA waived test
- 22Increased procedural services
- XESeparate encounter, a service that is distinct because it occurred during a separate encounter
- XPSeparate practitioner, a service that is distinct because it was performed by a different practitioner
- 57Decision for surgery
- 76Repeat procedure by the same physician
- FQThe service was furnished using audio-only communication technology
- 52Reduced services
- 58Staged or related procedure in the postoperative period
- 79Unrelated procedure in the postoperative period
- ASPhysician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery
- CQOutpatient physical therapy services furnished in whole or in part by a physical therapist assistant
- GCThis service has been performed in part by a resident under the direction of a teaching physician
- GOServices delivered under an outpatient occupational therapy plan of care
- 53Discontinued procedure
- 80Assistant surgeon
- 93Audio-only telemedicine
- GNServices delivered under an outpatient speech language pathology plan of care
- GWService not related to the hospice patient's terminal condition
- 77Repeat procedure by another physician
- 78Unplanned return to the operating room in the postoperative period
- 91Repeat clinical diagnostic lab test
- AAAnesthesia services performed personally by anesthesiologist
- COOutpatient occupational therapy services furnished in whole or in part by an occupational therapy assistant
- GXNotice of liability issued, voluntary under payer policy
- NUNew equipment
- PTColorectal cancer screening test; converted to diagnostic test or other procedure
- Q5Service 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
- Q6Service 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
- RRRental (use the 'RR' modifier when DME is to be rented)
Modifiers by use
- Distinct and repeat services59 XE XP XS XU 76 77 91
- Global surgery period24 25 57 58 78 79 54 55 56 FT
- Telehealth95 93 GT GQ FQ FR
- Liability notices and coverageGA GX GY GZ KX
- Professional and technical components26 TC
- Body side and siteRT LT 50 E1 E2 E3 E4 FA F1 TA T1
- Reduced or stopped services52 53 73 74 PT
- More than one surgeon62 66 80 81 82 AS
- Drug waste and 340BJW JZ JG TB
- Therapy plans of careGP GO GN CQ CO KX 96 97
- AnesthesiaAA AD QK QX QY QZ QS G8 G9 23 47
- Laboratory90 91 92 QW
- Equipment purchase and rentalNU RR UE KS
- Substitute physicians and teaching settingsQ5 Q6 GC 82
- HospiceGW GV
- Multiple procedures and modifiers51 59 99 50
CPT modifiers
- 22Increased procedural services
- 23Unusual anesthesia
- 24Unrelated E/M visit in the postoperative period
- 25Significant, separate E/M visit on the same day
- 26Professional component
- 27Multiple outpatient hospital E/M visits on the same date
- 32Mandated services
- 33Preventive services
- 47Anesthesia by the surgeon
- 50Bilateral procedure
- 51Multiple procedures
- 52Reduced services
- 53Discontinued procedure
- 54Surgical care only
- 55Postoperative management only
- 56Preoperative management only
- 57Decision for surgery
- 58Staged or related procedure in the postoperative period
- 59Distinct procedural service
- 62Two surgeons
- 63Procedure on an infant under 4 kg
- 66Surgical team
- 73Discontinued before anesthesia (hospital outpatient or ASC)
- 74Discontinued after anesthesia (hospital outpatient or ASC)
- 76Repeat procedure by the same physician
- 77Repeat procedure by another physician
- 78Unplanned return to the operating room in the postoperative period
- 79Unrelated procedure in the postoperative period
- 80Assistant surgeon
- 81Minimum assistant surgeon
- 82Assistant surgeon when no qualified resident was available
- 90Reference (outside) laboratory
- 91Repeat clinical diagnostic lab test
- 92Alternative laboratory platform testing
- 93Audio-only telemedicine
- 95Synchronous telemedicine (audio and video)
- 96Habilitative services
- 97Rehabilitative services
- 99Multiple modifiers
HCPCS Level II: A
- A1Dressing for one wound
- A2Dressing for two wounds
- A3Dressing for three wounds
- A4Dressing for four wounds
- A5Dressing for five wounds
- A6Dressing for six wounds
- A7Dressing for seven wounds
- A8Dressing for eight wounds
- A9Dressing for nine or more wounds
- AAAnesthesia services performed personally by anesthesiologist
- ABAudiology service furnished personally by an audiologist without a physician/NPP order for non-acute hearing assessment unrelated to disequilibrium, or hearing aids, or examinations for the purpose of prescribing, fitting, or changing hearing aids; service may be performed once every 12 months, per beneficiary
- ACInitial onboarding support payment for access beneficiary enrollment, device/app setup, and care coordination activities; first month only; once per beneficiary per track
- ADMedical supervision by a physician: more than four concurrent anesthesia procedures
- AERegistered dietician
- AFSpecialty physician
- AGPrimary physician
- AHClinical psychologist
- AIPrincipal physician of record
- AJClinical social worker
- AKNon participating physician
- AMPhysician, team member service
- AOAlternate payment method declined by provider of service
- APDetermination of refractive state was not performed in the course of diagnostic ophthalmological examination
- AQPhysician providing a service in an unlisted health professional shortage area (HPSA)
- ARPhysician provider services in a physician scarcity area
- ASPhysician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery
- ATAcute treatment (this modifier should be used when reporting service 98940, 98941, 98942)
- AUItem furnished in conjunction with a urological, ostomy, or tracheostomy supply
- AVItem furnished in conjunction with a prosthetic device, prosthetic or orthotic
- AWItem furnished in conjunction with a surgical dressing
- AXItem furnished in conjunction with dialysis services
- AYItem or service furnished to an ESRD patient that is not for the treatment of ESRD
- AZPhysician providing a service in a dental health professional shortage area for the purpose of an electronic health record incentive payment
HCPCS Level II: B
- BAItem furnished in conjunction with parenteral enteral nutrition (PEN) services
- BLSpecial acquisition of blood and blood products
- BOOrally administered nutrition, not by feeding tube
- BPThe beneficiary has been informed of the purchase and rental options and has elected to purchase the item
- BRThe beneficiary has been informed of the purchase and rental options and has elected to rent the item
- BUThe beneficiary has been informed of the purchase and rental options and after 30 days has not informed the supplier of his/her decision
HCPCS Level II: C
- CAProcedure payable only in the inpatient setting when performed emergently on an outpatient who expires prior to admission
- CBService 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
- CCProcedure code change (use 'CC' when the procedure code submitted was changed either for administrative reasons or because an incorrect code was filed)
- CDAMCC test has been ordered by an ESRD facility or MCP physician that is part of the composite rate and is not separately billable
- CEAMCC 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
- CFAMCC test has been ordered by an ESRD facility or MCP physician that is not part of the composite rate and is separately billable
- CGPolicy criteria applied
- CH0 percent impaired, limited or restricted
- CIAt least 1 percent but less than 20 percent impaired, limited or restricted
- CJAt least 20 percent but less than 40 percent impaired, limited or restricted
- CKAt least 40 percent but less than 60 percent impaired, limited or restricted
- CLAt least 60 percent but less than 80 percent impaired, limited or restricted
- CMAt least 80 percent but less than 100 percent impaired, limited or restricted
- CN100 percent impaired, limited or restricted
- COOutpatient occupational therapy services furnished in whole or in part by an occupational therapy assistant
- CPAdjunctive service related to a procedure assigned to a comprehensive ambulatory payment classification (c-apc) procedure, but reported on a different claim
- CQOutpatient physical therapy services furnished in whole or in part by a physical therapist assistant
- CRCatastrophe/disaster related
- CSCost-sharing waived for specified COVID-19 testing-related services that result in and order for or administration of a COVID-19 test and/or used for cost-sharing waived preventive services furnished via telehealth in rural health clinics and federally qualified health centers during the COVID-19 public health emergency
- CTComputed tomography services furnished using equipment that does not meet each of the attributes of the national electrical manufacturers association (NEMA) xr-29-2013 standard
HCPCS Level II: D
HCPCS Level II: E
- E1Upper left, eyelid
- E2Lower left, eyelid
- E3Upper right, eyelid
- E4Lower right, eyelid
- EAErythropoietic stimulating agent (ESA) administered to treat anemia due to anti-cancer chemotherapy
- EBErythropoietic stimulating agent (ESA) administered to treat anemia due to anti-cancer radiotherapy
- ECErythropoietic stimulating agent (ESA) administered to treat anemia not due to anti-cancer radiotherapy or anti-cancer chemotherapy
- EDHematocrit 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
- EEHematocrit 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
- EJSubsequent claims for a defined course of therapy, e.g., epo, sodium hyaluronate, infliximab
- EMEmergency reserve supply (for ESRD benefit only)
- EPService provided as part of medicaid early periodic screening diagnosis and treatment (EPSDT) program
- ERItems and services furnished by a provider-based, off-campus emergency department
- ETEmergency services
- EXExpatriate beneficiary
- EYNo physician or other licensed health care provider order for this item or service
HCPCS Level II: F
- F1Left hand, second digit
- F2Left hand, third digit
- F3Left hand, fourth digit
- F4Left hand, fifth digit
- F5Right hand, thumb
- F6Right hand, second digit
- F7Right hand, third digit
- F8Right hand, fourth digit
- F9Right hand, fifth digit
- FALeft hand, thumb
- FBItem 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)
- FCPartial credit received for replaced device
- FPService provided as part of family planning program
- FQThe service was furnished using audio-only communication technology
- FRThe supervising practitioner was present through two-way, audio/video communication technology
- FSSplit (or shared) evaluation and management visit
- FTUnrelated evaluation and management (E/M) visit on the same day as another E/M visit or during a global procedure (preoperative, postoperative period, or on the same day as the procedure, as applicable). (report when an E/M visit is furnished within the global period but is unrelated, or when one or more additional E/M visits furnished on the same day are unrelated)
- FXX-ray taken using film
- FYX-ray taken using computed radiography technology/cassette-based imaging
HCPCS Level II: G
- G0Telehealth services for diagnosis, evaluation, or treatment, of symptoms of an acute stroke
- G1Most recent urr reading of less than 60
- G2Most recent urr reading of 60 to 64.9
- G3Most recent urr reading of 65 to 69.9
- G4Most recent urr reading of 70 to 74.9
- G5Most recent urr reading of 75 or greater
- G6ESRD patient for whom less than six dialysis sessions have been provided in a month
- G7Pregnancy resulted from rape or incest or pregnancy certified by physician as life threatening
- G8Monitored anesthesia care (MAC) for deep complex, complicated, or markedly invasive surgical procedure
- G9Monitored anesthesia care for patient who has history of severe cardio-pulmonary condition
- GAWaiver of liability statement issued as required by payer policy, individual case
- GBClaim being re-submitted for payment because it is no longer covered under a global payment demonstration
- GCThis service has been performed in part by a resident under the direction of a teaching physician
- GDUnits of service exceeds medically unlikely edit value and represents reasonable and necessary services
- GEThis service has been performed by a resident without the presence of a teaching physician under the primary care exception
- GFNon-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
- GGPerformance and payment of a screening mammogram and diagnostic mammogram on the same patient, same day
- GHDiagnostic mammogram converted from screening mammogram on same day
- GJ"opt out" physician or practitioner emergency or urgent service
- GKReasonable and necessary item/service associated with a ga or gz modifier
- GLMedically unnecessary upgrade provided instead of non-upgraded item, no charge, no advance beneficiary notice (ABN)
- GMMultiple patients on one ambulance trip
- GNServices delivered under an outpatient speech language pathology plan of care
- GOServices delivered under an outpatient occupational therapy plan of care
- GPServices delivered under an outpatient physical therapy plan of care
- GQVia asynchronous telecommunications system
- GRThis 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
- GSDosage of erythropoietin stimulating agent has been reduced and maintained in response to hematocrit or hemoglobin level
- GTVia interactive audio and video telecommunication systems
- GUWaiver of liability statement issued as required by payer policy, routine notice
- GVAttending physician not employed or paid under arrangement by the patient's hospice provider
- GWService not related to the hospice patient's terminal condition
- GXNotice of liability issued, voluntary under payer policy
- GYItem or service statutorily excluded, does not meet the definition of any medicare benefit or, for non-medicare insurers, is not a contract benefit
- GZItem or service expected to be denied as not reasonable and necessary
HCPCS Level II: H
- H9Court-ordered
- HAChild/adolescent program
- HBAdult program, non geriatric
- HCAdult program, geriatric
- HDPregnant/parenting women's program
- HEMental health program
- HFSubstance abuse program
- HGOpioid addiction treatment program
- HHIntegrated mental health/substance abuse program
- HIIntegrated mental health and intellectual disability/developmental disabilities program
- HJEmployee assistance program
- HKSpecialized mental health programs for high-risk populations
- HLIntern
- HMLess than bachelor degree level
- HNBachelors degree level
- HOMasters degree level
- HPDoctoral level
- HQGroup setting
- HRFamily/couple with client present
- HSFamily/couple without client present
- HTMulti-disciplinary team
- HUFunded by child welfare agency
- HVFunded state addictions agency
- HWFunded by state mental health agency
- HXFunded by county/local agency
- HYFunded by juvenile justice agency
- HZFunded by criminal justice agency
HCPCS Level II: J
- J1Competitive acquisition program no-pay submission for a prescription number
- J2Competitive acquisition program, restocking of emergency drugs after emergency administration
- J3Competitive acquisition program (CAP), drug not available through cap as written, reimbursed under average sales price methodology
- J4DMEPOS item subject to DMEPOS competitive bidding program that is furnished by a hospital upon discharge
- J5Off-the-shelf orthotic subject to DMEPOS competitive bidding program that is furnished as part of a physical therapist or occupational therapist professional service
- JAAdministered intravenously
- JBAdministered subcutaneously
- JCSkin substitute used as a graft
- JDSkin substitute not used as a graft
- JEAdministered via dialysate
- JFCompounded drug
- JGDrug or biological acquired with 340b drug pricing program discount, reported for informational purposes
- JKOne month supply or less of drug or biological
- JLThree month supply of drug or biological
- JWDrug amount discarded/not administered to any patient
- JZZero drug amount discarded/not administered to any patient
HCPCS Level II: K
- K0Lower 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.
- K1Lower 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.
- K2Lower 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.
- K3Lower 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.
- K4Lower 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.
- KAAdd on option/accessory for wheelchair
- KBBeneficiary requested upgrade for ABN, more than 4 modifiers identified on claim
- KCReplacement of special power wheelchair interface
- KDDrug or biological infused through DME
- KEBid under round one of the DMEPOS competitive bidding program for use with non-competitive bid base equipment
- KFItem designated by FDA as class III device
- KGDMEPOS item subject to DMEPOS competitive bidding program number 1
- KHDMEPOS item, initial claim, purchase or first month rental
- KIDMEPOS item, second or third month rental
- KJDMEPOS item, parenteral enteral nutrition (PEN) pump or capped rental, months four to fifteen
- KKDMEPOS item subject to DMEPOS competitive bidding program number 2
- KLDMEPOS item delivered via mail
- KMReplacement of facial prosthesis including new impression/moulage
- KNReplacement of facial prosthesis using previous master model
- KOSingle drug unit dose formulation
- KPFirst drug of a multiple drug unit dose formulation
- KQSecond or subsequent drug of a multiple drug unit dose formulation
- KRRental item, billing for partial month
- KSGlucose monitor supply for diabetic beneficiary not treated with insulin
- KTBeneficiary resides in a competitive bidding area and travels outside that competitive bidding area and receives a competitive bid item
- KUDMEPOS item subject to DMEPOS competitive bidding program number 3
- KVDMEPOS item subject to DMEPOS competitive bidding program that is furnished as part of a professional service
- KWDMEPOS item subject to DMEPOS competitive bidding program number 4
- KXRequirements specified in the medical policy have been met
- KYDMEPOS item subject to DMEPOS competitive bidding program number 5
- KZNew coverage not implemented by managed care
HCPCS Level II: L
- L1Provider attestation that the hospital laboratory test(s) is not packaged under the hospital OPPS
- LCLeft circumflex coronary artery
- LDLeft anterior descending coronary artery
- LLLease/rental (use the 'LL' modifier when DME equipment rental is to be applied against the purchase price)
- LMLeft main coronary artery
- LRLaboratory round trip
- LSFDA-monitored intraocular lens implant
- LTLeft side (used to identify procedures performed on the left side of the body)
- LUFractionated payment
HCPCS Level II: M
- M2Medicare secondary payer (MSP)
- MAOrdering 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
- MBOrdering professional is not required to consult a clinical decision support mechanism due to the significant hardship exception of insufficient internet access
- MCOrdering 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
- MDOrdering professional is not required to consult a clinical decision support mechanism due to the significant hardship exception of extreme and uncontrollable circumstances
- METhe order for this service adheres to appropriate use criteria in the clinical decision support mechanism consulted by the ordering professional
- MFThe order for this service does not adhere to the appropriate use criteria in the clinical decision support mechanism consulted by the ordering professional
- MGThe order for this service does not have applicable appropriate use criteria in the qualified clinical decision support mechanism consulted by the ordering professional
- MHUnknown if ordering professional consulted a clinical decision support mechanism for this service, related information was not provided to the furnishing professional or provider
- MSSix month maintenance and servicing fee for reasonable and necessary parts and labor which are not covered under any manufacturer or supplier warranty
HCPCS Level II: N
- N1Group 1 oxygen coverage criteria met
- N2Group 2 oxygen coverage criteria met
- N3Group 3 oxygen coverage criteria met
- NBNebulizer system, any type, FDA-cleared for use with specific drug
- NRNew when rented (use the 'NR' modifier when DME which was new at the time of rental is subsequently purchased)
- NUNew equipment
HCPCS Level II: P
- P1A normal healthy patient
- P2A patient with mild systemic disease
- P3A patient with severe systemic disease
- P4A patient with severe systemic disease that is a constant threat to life
- P5A moribund patient who is not expected to survive without the operation
- P6A declared brain-dead patient whose organs are being removed for donor purposes
- PASurgical or other invasive procedure on wrong body part
- PBSurgical or other invasive procedure on wrong patient
- PCWrong surgery or other invasive procedure on patient
- PDDiagnostic 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
- PIPositron 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
- PLProgressive addition lenses
- PMPost mortem
- PNNon-excepted service provided at an off-campus, outpatient, provider-based department of a hospital
- POExcepted service provided at an off-campus, outpatient, provider-based department of a hospital
- PSPositron 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
- PTColorectal cancer screening test; converted to diagnostic test or other procedure
HCPCS Level II: Q
- Q0Investigational clinical service provided in a clinical research study that is in an approved clinical research study
- Q1Routine clinical service provided in a clinical research study that is in an approved clinical research study
- Q2Demonstration procedure/service
- Q3Live kidney donor surgery and related services
- Q4Service for ordering/referring physician qualifies as a service exemption
- Q5Service 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
- Q6Service 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
- Q7One class a finding
- Q8Two class b findings
- Q9One class b and two class c findings
- QAPrescribed 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)
- QBPrescribed 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
- QCSingle channel monitoring
- QDRecording and storage in solid state memory by a digital recorder
- QEPrescribed amount of stationary oxygen while at rest is less than 1 liter per minute (LPM)
- QFPrescribed amount of stationary oxygen while at rest exceeds 4 liters per minute (LPM) and portable oxygen is prescribed
- QGPrescribed amount of stationary oxygen while at rest is greater than 4 liters per minute (LPM)
- QHOxygen conserving device is being used with an oxygen delivery system
- QJServices/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)
- QKMedical direction of two, three, or four concurrent anesthesia procedures involving qualified individuals
- QLPatient pronounced dead after ambulance called
- QMAmbulance service provided under arrangement by a provider of services
- QNAmbulance service furnished directly by a provider of services
- QPDocumentation 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.
- QQOrdering professional consulted a qualified clinical decision support mechanism for this service and the related data was provided to the furnishing professional
- QRPrescribed 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)
- QSMonitored anesthesia care service
- QTRecording and storage on tape by an analog tape recorder
- QWCLIA waived test
- QXCRNA service: with medical direction by a physician
- QYMedical direction of one certified registered nurse anesthetist (CRNA) by an anesthesiologist
- QZCRNA service: without medical direction by a physician
HCPCS Level II: R
- RAReplacement of a DME, orthotic or prosthetic item
- RBReplacement of a part of a DME, orthotic or prosthetic item furnished as part of a repair
- RCRight coronary artery
- RDDrug provided to beneficiary, but not administered "incident-to"
- REFurnished in full compliance with FDA-mandated risk evaluation and mitigation strategy (REMS)
- RIRamus intermedius coronary artery
- RRRental (use the 'RR' modifier when DME is to be rented)
- RTRight side (used to identify procedures performed on the right side of the body)
HCPCS Level II: S
- SANurse practitioner rendering service in collaboration with a physician
- SBNurse midwife
- SCMedically necessary service or supply
- SDServices provided by registered nurse with specialized, highly technical home infusion training
- SEState and/or federally-funded programs/services
- SFSecond opinion ordered by a professional review organization (PRO) per section 9401, p.l. 99-272 (100% reimbursement - no medicare deductible or coinsurance)
- SGAmbulatory surgical center (ASC) facility service
- SHSecond concurrently administered infusion therapy
- SJThird or more concurrently administered infusion therapy
- SKMember of high risk population (use only with codes for immunization)
- SLState supplied vaccine
- SMSecond surgical opinion
- SNThird surgical opinion
- SQItem ordered by home health
- SSHome infusion services provided in the infusion suite of the IV therapy provider
- STRelated to trauma or injury
- SUProcedure performed in physician's office (to denote use of facility and equipment)
- SVPharmaceuticals delivered to patient's home but not utilized
- SWServices provided by a certified diabetic educator
- SYPersons who are in close contact with member of high-risk population (use only with codes for immunization)
- SZHabilitative services
HCPCS Level II: T
- T1Left foot, second digit
- T2Left foot, third digit
- T3Left foot, fourth digit
- T4Left foot, fifth digit
- T5Right foot, great toe
- T6Right foot, second digit
- T7Right foot, third digit
- T8Right foot, fourth digit
- T9Right foot, fifth digit
- TALeft foot, great toe
- TBDrug or biological acquired with 340b drug pricing program discount, reported for informational purposes
- TCTechnical 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
- TDRn
- TELpn/lvn
- TFIntermediate level of care
- TGComplex/high tech level of care
- THObstetrical treatment/services, prenatal or postpartum
- TJProgram group, child and/or adolescent
- TKExtra patient or passenger, non-ambulance
- TLEarly intervention/individualized family service plan (IFSP)
- TMIndividualized education program (IEP)
- TNRural/outside providers' customary service area
- TPMedical transport, unloaded vehicle
- TQBasic life support transport by a volunteer ambulance provider
- TRSchool-based individualized education program (IEP) services provided outside the public school district responsible for the student
- TSFollow-up service
- TTIndividualized service provided to more than one patient in same setting
- TUSpecial payment rate, overtime
- TVSpecial payment rates, holidays/weekends
- TWBack-up equipment
HCPCS Level II: U
- U1Medicaid level of care 1, as defined by each state
- U2Medicaid level of care 2, as defined by each state
- U3Medicaid level of care 3, as defined by each state
- U4Medicaid level of care 4, as defined by each state
- U5Medicaid level of care 5, as defined by each state
- U6Medicaid level of care 6, as defined by each state
- U7Medicaid level of care 7, as defined by each state
- U8Medicaid level of care 8, as defined by each state
- U9Medicaid level of care 9, as defined by each state
- UAMedicaid level of care 10, as defined by each state
- UBMedicaid level of care 11, as defined by each state
- UCMedicaid level of care 12, as defined by each state
- UDMedicaid level of care 13, as defined by each state
- UEUsed durable medical equipment
- UFServices provided in the morning
- UGServices provided in the afternoon
- UHServices provided in the evening
- UJServices provided at night
- UKServices provided on behalf of the client to someone other than the client (collateral relationship)
- UNTwo patients served
- UPThree patients served
- UQFour patients served
- URFive patients served
- USSix or more patients served
HCPCS Level II: V
- V1Demonstration modifier 1
- V2Demonstration modifier 2
- V3Demonstration modifier 3
- V4Demonstration modifier 4
- V5Vascular catheter (alone or with any other vascular access)
- V6Arteriovenous graft (or other vascular access not including a vascular catheter)
- V7Arteriovenous fistula only (in use with two needles)
- V8Infection present
- V9No infection present
- VMMedicare diabetes prevention program (MDPP) virtual make-up session
- VPAphakic patient
HCPCS Level II: X
- X1Continuous/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
- X2Continuous/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
- X3Episodic/broad services: 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
- X4Episodic/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
- X5Diagnostic 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
- XESeparate encounter, a service that is distinct because it occurred during a separate encounter
- XPSeparate practitioner, a service that is distinct because it was performed by a different practitioner
- XSSeparate structure, a service that is distinct because it was performed on a separate organ/structure
- XUUnusual non-overlapping service, the use of a service that is distinct because it does not overlap usual components of the main service
HCPCS Level II: Z
Questions
What is a billing modifier?
A two-character code added to a procedure code on a claim line. It tells the payer something about the service, such as which side of the body, that it was a separate service, or that it was done by telehealth.
What is the difference between CPT and HCPCS modifiers?
CPT (Level I) modifiers are two digits, such as 25 or 59, and are maintained by the AMA. HCPCS Level II modifiers have a letter, such as GT or XU, and are published by CMS in the quarterly HCPCS file.
How many modifiers can go on one claim line?
Up to four on the CMS-1500 (item 24D) and on an 837P line.
Why are CPT modifier descriptions written differently here?
CPT descriptors are AMA copyright. This site writes its own plain description for each CPT modifier and links the CMS guidance that covers Medicare's use.