HCPCS Level II modifier
Modifier CG
Modifier CG is a HCPCS Level II modifier. CMS describes it as: Policy criteria applied.
Source: CMS HCPCS Level II, October 2026 file dated September 23, 2026. Publisher page
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- Modifier
- CG
- Type
- HCPCS Level II modifier, maintained by CMS
- CMS description
- Policy criteria applied
- Claim form
- CMS-1500 item 24D, up to four modifiers per line. 837P SV101-3 to SV101-6.
- Guidance
- CMS HCPCS quarterly update
Related modifiers
- CH0 percent impaired, limited or restricted
- CFAMCC test has been ordered by an ESRD facility or MCP physician that is not part of the composite rate and is separately billable
- CIAt least 1 percent but less than 20 percent impaired, limited or restricted
- 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
- CJAt least 20 percent but less than 40 percent impaired, limited or restricted
- CDAMCC test has been ordered by an ESRD facility or MCP physician that is part of the composite rate and is not separately billable
- CKAt least 40 percent but less than 60 percent impaired, limited or restricted
- CCProcedure code change (use 'CC' when the procedure code submitted was changed either for administrative reasons or because an incorrect code was filed)
Related pages
Questions
What does modifier CG mean?
Modifier CG is a HCPCS Level II modifier. CMS describes it as: Policy criteria applied.
Is modifier CG a CPT or a HCPCS modifier?
CG is a HCPCS Level II modifier from the CMS quarterly HCPCS file. Two-digit numeric modifiers, such as 25 or 59, are CPT modifiers.
Where does modifier CG go on a claim?
On the CMS-1500 it goes in item 24D next to the procedure code. Each line holds up to four modifiers. On an 837P it goes in SV101-3 to SV101-6.
What denial comes back when a modifier is wrong?
A missing or mismatched modifier often comes back as CARC 4. A modifier that was not valid on the date of service comes back as CARC 182. A bundling edit the modifier should have bypassed comes back as CARC 97 or 236.