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
