Thursday, August 27, 2015

Additional HCPCS Modifiers



Modifier    Description
AE    Registered Dietician
AF    Specialty Physician
AG    Primary Physician
AH    Clinical Psychologist
AI    Principal Physician of Record
AJ    Clinical Social Worker
AK    Non Participating Physician
AM    Physician, team member service
AS    Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery. Must be reported with a Assistant Surgeon modifier (i.e. 80, 81, 82)
AT    Acute Treatment
For dates of service on or after October 12, 2007, modifier AT is required on all claims for tetanus or rabies injection(s).
Chiropractors must bill the AT modifier when reporting HCPCS codes 98940, 98941, 98942 to indicate active/corrective treatment. Claims submitted without the AT modifier will be denied for maintenance therapy.
AX    Item furnished in conjunction with dialysis services
AY    Item or service furnished to an ESRD patient that is not for the treatment of ERSD
AZ    Physician providing a service in a dental Health Professional Shortage Area for the purpose of an Electronic Health Record Incentive Payment
BL    Special Acquisition of blood and blood products
CA    Procedure payable only in the inpatient setting when performed emergently on an outpatient who expires prior to admission.
CB    Services ordered by a dialysis physician as part of the ESRD beneficiary’s dialysis benefit, is not part of the composite rate and is separately reimbursable.
CD    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    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 test has been ordered by an ESRD facility or MCP physician that is not part of the composite rate and is separately billable
CH    0 percent impaired, limited or restricted
CI    At least 1 percent but less than 20 percent impaired, limited or restricted
CJ    At least 20 percent but less than 40 percent impaired, limited or restricted
CK    At least 40 percent but less than 60 percent impaired, limited or restricted
CL    At least 60 percent but less than 80 percent impaired, limited or restricted
CM    At least 80 percent but less than 100 percent impaired, limited or restricted
CN    100 percent impaired, limited or restricted
CR    Catastrophe/Disaster Related
CS    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.
DA    Oral health assessment by a licensed Health Professional other than a dentist
EA    Erythropetic stimulating agent (ESA) administered to treat anemia due to anti-cancer chemotherapy
EB    Erythropetic stimulating agent (ESA) administered to treat anemia due to anti-cancer radiotherapy.
EC    Erythropetic stimulating agent (ESA) administered to treat anemia not due to anti-cancer radiotherapy or anti-cancer chemotherapy
ED    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    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 claims for a defined course of therapy, e.g., EPO, Sodium Hyaluronate, Infliximab
E1    Upper left, eyelid
E2    Lower left, eyelid
E3    Upper right, eyelid
E4    Lower right, eyelid
ET    Emergency Services
FA    Left Hand, thumb
FB    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    Partial credit received for replaced device
F1    Left hand, second digit
F2    Left hand, third digit
F3    Left hand, fourth digit
F4    Left hand, fifth digit
F5    Right hand, thumb
F6    Right hand, second digit
F7    Right hand, third digit
F8    Right hand, fourth digit
F9    Right hand, fifth digit
G6    ESRD patient for whom less than six dialysis sessions have been provided in a month
G7    Pregnancy resulted from rape or incest or pregnancy certified by physicians as life threatening.
GA    Beneficiary authorization
Report this modifier to indicate that advance written notice was provided to the beneficiary of the likelihood of denial of a service as being not reasonable and necessary under Medicare guidelines.
GC    This service has been performed in part by a resident under the direction of a teaching physician.
GD    Units of service exceeds medically unlikely edit value and represents reasonable and necessary services.
GE    This service has been performed by a resident without the presence of a teaching physician under the primary care exception.
Note: Modifier GE for this purpose, is for use on all services except ambulance.
GG    Performance and payment of screening mammogram and diagnostic mammogram on the same patient, same day
GH    Diagnostic mammogram converted from screening mammogram on the same day
GM    Multiple patients on one ambulance trip
GN    Service delivered personally by a speech-language pathologist or under an outpatient speech-language pathology plan of care
GO    Service delivered personally by an occupational therapist or under an outpatient occupational therapy plan of care
GP    Service delivered personally by a physical therapist or under an outpatient physical therapy plan of care
GR    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.
GT    Via interactive audio and video telecommunication systems
GU    Waiver of liability statement issued as required by a payer policy, routine notice
GV    Attending physician not employed or paid under arrangement by the patient’s hospice provider
GW    Service not related to the hospice patients terminal condition
GX    Notice of liability issued, voluntary under payer policy
GY    Item or service statutorily excluded, does not meet the definition of any Medicare benefit or, for Non-Medicare Insurers, is not a contract benefit.
The GY modifier should be used when billing for items or services that are statutorily excluded or do not meet the definition of any Medicare benefit. Example: routine physical exam. All services reported with the GY modifier will be denied by Medicare.
GZ    Item or service expected to be denied as not reasonable and necessary
J1    Competitive Acquisition Program, no-pay submission for a prescription number
J2    Competitive Acquisition Program, restocking of emergency drugs after emergency administration
J3    Competitive Acquisition Program, (CAP) drug not available through CAP as written, reimburse under ASP Methodology
JA    Administered Intravenously
JB    Administered Subcutaneously
JC    Skin substitute used as a graft
JD    Skin substitute NOT used as a graft
KC    Replacement of special power wheelchair interface
KD    Drug or biological infused through DME
KE    Bid under round one of the DMEPOS competitive bidding program for use with non-competitive bid base equipment
KF    Item designated by FDA as Class III device
KX    Requirements specified in the Medical Policy have been met
KZ    New coverage not implemented by managed care
L1    Separate payment for outpatient lab tests under the Clinical Laboratory Fee Schedule (CLFS) in the following circumstances:
A hospital collects specimen and furnishes only the outpatient labs on a given date of service; or
A hospital conducts outpatient lab tests that are clinically unrelated to other hospital outpatient services furnished the same day.
Note: “Unrelated” means the laboratory test is ordered by a different practitioner than the practitioner who ordered other hospital outpatient services and for a different diagnosis. Hospitals should no longer use TOB 14X in these circumstances.

LC    Left circum coronary artery
LD    Left ant des coronary artery
LM    Left main coronary artery
LT    Left Side (used to identify procedures performed on the left side of the body)
If used to substantiate different body sites, this modifier can exclude services from rebundling
M2    Medicare Secondary Payer for CAP
NB    Nebulizer system, any type, FDA-Cleared fo ruse with specific drug
PA    Surgery, wrong body part
PB    Surgery, wrong patient
PC    Wrong surgery on patient
PD    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 strategy
PS    PET Tumor subsq tx strategy
PT    Colorectal cancer screening test; converted to diagnostic test or other procedure
Q0    Investigational clinical service provided in a clinical research study that is in an approved clinical research study.
Q1    Routine clinical service provided in a clinical research study that is in an approved clinical research study.
Q3    Live kidney donor surgery and related services
Services will be reimbursed at 100% of the allowed charge as required in Section 1881 (d) of the Social Security Act. The following bullets are some reporting notes and tips for submitting kidney donor services:
In the event that more than two modifiers are required when reporting postoperative physician services furnished to live kidney donors, it is important that the Q3 modifier is reported in the first modifier position. This is necessary to ensure that these services are reimbursed at 100%.
Services are to be reported under the name and HIC number of the recipient of the kidney donation.
Procedure code 50320, Donor nephrectomy from living donor 50547
Q4    Service for ordering/referring physician qualifies as a service exemption for laboratory services
Q5    Service furnished by a substitute physician under a reciprocal billing arrangement
Q6    Service furnished by a locum tenens physician
Q7    One Class A Finding
Note: Modifiers Q7, Q8, and Q9 are to be used to bill podiatric services.
Q8    Two Class B Findings
Note: Modifiers Q7, Q8, and Q9 are to be used to bill podiatric services.
Q9    One Class B and Two Class C Findings
Note: Modifiers Q7, Q8, and Q9 are to be used to bill podiatric services.
QL    Patient pronounced dead after ambulance called
QP    Documentation is on file showing that the lab test(s) was ordered individually or ordered as a CPT-recognized panel other than automated profile codes 80002-80019, G0058, G0059 and G0060.
QW    CLIA Waived Tests
RA    Replacement of a DME item, Orthotic or Prosthetic Item
RB    Replacement of a Part of DME, Orthotic or Prosthetic Item furnished as Part of a Repair
RD    Drug provided to beneficiary, but not, administrated incident-to
RE    Furnished in full compliance with FDA-Mandated Risk Evaluation and Mitigation Strategy (REMS)
RP    Replacement and repair
RT    Right side (used to identify procedures performed on the right side of the body) If used to substantiate different body sites, this modifier can exclude services from rebundling.
SF    Second opinion ordered by a Professional Review Organization (PRO) per section 9401, P.L. 99-272 (100 % reimbursement – no Medicare deductible or coinsurance)
SS    Home infusion services provided in the infusion suite of the IV therapy provider
SW    Services provided by a certified diabetes educator
TA    Left foot, great toe
T1    Left foot, second digit
T2    Left foot, third digit
T3    Left foot, fourth digit
T4    Left foot, fifth digit
T5    Right foot, great toe
T6    Right foot, second digit
T7    Right foot, third digit
T8    Right foot, fourth digit
T9    Right foot, fifth digit
Note: These modifiers can be used to indicate that comprehensive or component code combinations were performed on different digits. Separate payment will be allowed when column I & II services are performed on different digits.
TC    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 code number. This modifier must be reported in the first modifier field.
TS    Follow-up service
UN    Two Patients Served: This modifier is needed when transportation of portable x-ray equipment (R0075) is billed.
UP    Three Patients Served: This modifier is needed when transportation of portable x-ray equipment (R0075) is billed.
UQ    Four Patients Served: This modifier is needed when transportation of portable x-ray equipment (R0075) is billed
UR    Five Patients Served: This modifier is needed when transportation of portable x-ray equipment (R0075) is billed.
US    Six Patients Served: This modifier is needed when transportation of portable x-ray equipment (R0075) is billed.
V5    Any Vascular Catheter (alone or with any other vascular access) - Part A only modifier
V6    Arteriovenous Graft (or other vascular access not including a vascular catheter) - Part A only modifier
V7    Afteriovenous Fistula (or other vascular access not including a vascular catheter) - Part A only modifier
V8    Dialysis related infection present during the billing month - Part A only modifier
V9    No dialysis related infection present during the billing month - Part A only modifier

1 comment:

  1. Thanks for the article. very useful
    Get more info on IV Therapy

    ReplyDelete

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