HCPCS Level II modifier
Modifier Q4
Modifier Q4 is a HCPCS Level II modifier. CMS describes it as: Service for ordering/referring physician qualifies as a service exemption.
Source: CMS HCPCS Level II, October 2026 file dated September 23, 2026. Publisher page
Run it in Rivvi
Check the codes on your claims export
Upload a claims export. Rivvi flags ICD-10 and HCPCS codes that are not billable or are replaced. It does not check modifiers.
Check my exportFree to start. Opens Rivvi, the AI workspace for healthcare teams.
- Modifier
- Q4
- Type
- HCPCS Level II modifier, maintained by CMS
- CMS description
- Service for ordering/referring physician qualifies as a service exemption
- 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
- 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
- Q3Live kidney donor surgery and related services
- 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
- Q2Demonstration procedure/service
- Q7One class a finding
- Q1Routine clinical service provided in a clinical research study that is in an approved clinical research study
- Q8Two class b findings
- Q0Investigational clinical service provided in a clinical research study that is in an approved clinical research study
Related pages
Questions
What does modifier Q4 mean?
Modifier Q4 is a HCPCS Level II modifier. CMS describes it as: Service for ordering/referring physician qualifies as a service exemption.
Is modifier Q4 a CPT or a HCPCS modifier?
Q4 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 Q4 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.