|
Modifier
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Special Instructions/Notes (if applicable)
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Surgeons
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50
|
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53
|
Used for physician reporting of a discontinued procedure. For outpatient/ASC reporting of a discontinued procedure, see modifier 73 and 74.
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54+
|
Surgeons who do not provide the postoperative care for a patient must bill the surgery code with modifier 54. The modifier will reimburse the surgeon at 80 percent of the allowed amount.
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55+
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Physicians who provide only the postoperative care may bill the appropriate visit codes and must use modifier 55 to indicate only postoperative care services were provided. Services indicated as postoperative care only by use of this modifier will not be denied as part of the global surgical fee.
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62+
|
Cosurgery. Two surgeons perform the specific procedure(s).
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66+
|
Cosurgery. Two surgeons are necessary to perform the highly complex surgical procedure(s).
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76+
|
Use modifier 76 or 77 for transplant procedures if it is a second transplant of the same organ.
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|
77+
|
Use modifier 76 or 77 for transplant procedures if it is a second transplant of the same organ.
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|
SF
|
|
|
Assistant Surgeons
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80 and KX+
|
Use modifier 80 and KX together to indicate an assistant surgeon in a teaching facility:
• In a case involving exceptional medical circumstances such as emergency or life-threatening situations requiring immediate attention.
•When the primary surgeon has a policy of never, without exception, involving a resident in the preoperative, operative, or postoperative care of one of his or her patients.
•In a case involving a complex surgical procedure that qualifies for more than one physician.
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|
AS
|
|
|
Excision of Lesions/Masses
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|
KX+
|
Use modifier KX if the excision/destruction is due to one of the following signs or symptoms: inflamed, infected, bleeding, irritated, growing, limiting motion or function. Use of this modifier is subject to retrospective review.
|
|
Routine Foot Care
|
|
TT+
|
Use with routine foot care procedures rendered in a nursing home when multiple patients are seen.
|
|
Injections
|
|
ET+
|
|
|
JA
|
Administered intravenously
|
|
JB
|
Administered subcutaneously
|
|
KX+
|
Use modifier KX to indicate the injection was due to:
•Oral route contraindicated or an acceptable oral equivalent is not available.
•Injectable medication is the accepted treatment of choice. Oral medication regimens have proven ineffective or are not available.
•Patient has a temperature over 102 degrees (documented on the claim) and a high level of antibiotic is needed quickly.
•Injection is medically necessary into joints, bursae, tendon sheaths, or trigger points to treat an acute condition or the acute flare up of a chronic condition.
|
|
Visits
|
|
52+
|
Use with normal newborn care if the service did not comprise a THSteps screen.
|
|
76+
|
|
|
FP+
|
|
|
TH+
|
Use with evaluation and management procedures to specify antepartum or postpartum care.
|
|
25
|
Used to describe circumstances in which an office visit was provided at the same time as other separately identifiable services.
|
|
Anesthesia
|
|
One of the following modifiers must be used by physicians in conjunction with the CPT code for anesthesia services:
|
|
AA
|
|
|
AD
|
|
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QK
|
|
|
Modifier FP must be used when billing anesthesia for a sterilization procedure
|
|
FQHC and RHC
|
|
Services provided by a health-care professional require one of the following modifiers:
|
|
AH
|
|
|
AJ
|
|
|
AM
|
|
|
SA
|
|
|
TD
|
For home services provided in areas with a shortage of home health agencies.
|
|
TE
|
For home services provided in areas with a shortage of home health agencies.
|
|
U1
|
|
|
U2
|
|
|
U7*
|
Physician assistant services for other than assistant at surgery
|
|
The following modifiers may be used in addition to the modifier identifying the health-care professional that rendered the service:
|
|
EP
|
|
|
FP
|
|
|
GT
|
If the encounter is using telemedicine, use GT in the second modifier field.
|
|
TH
|
|
|
TU
|
For services provided outside of normal business hours to a client enrolled in the PCCM program.
|
|
Certified Registered Nurse Anesthetist (CRNA)
|
|
One of the following modifiers must be used by CRNAs in conjunction with the CPT code for anesthesia services:
|
|
QX
|
|
|
QZ
|
|
|
The following modifier must be used when billing anesthesia for a sterilization procedure:
|
|
FP
|
|
|
Abortion
|
|
G7
|
|
|
Vision
|
|
RP+
|
Use modifier RP to indicate replacement lenses and/or frames
|
|
VP+
|
|
|
Laboratory/Radiology
|
|
26+
|
Used with TOS I (interpretation) for laboratory and radiological procedures.
|
|
91+
|
|
|
FP+
|
Use with 99000 for lab handling services related to family planning.
|
|
SU+
|
Indicates necessary equipment is in physician's office for RAST/MAST testing or Pap smears.
|
|
TC+
|
The modifier TC is used with TOS T (technical) for radiological procedures.
|
|
TS
|
Use with 76811 or 76812 to indicate a follow-up or repeat ultrasound exam.
|
|
Q4+
|
Use for lab/radiology/ultrasound interps by other than the attending physician.
|
|
Therapy
|
|
AT+
|
Must be used to indicate the necessity of an acute condition for occupational therapy (OT), physical therapy (PT), osteopathic manipulation treatment (OMT), or chiropractic services.
|
|
GN
|
|
|
GO
|
|
|
GP
|
|
|
U4*
|
Reassessment
|
|
THSteps Medical
|
|
AM
|
|
|
EP
|
FQHCs must use modifier EP for services provided under THSteps.
|
|
SA
|
|
|
U7*
|
Physician assistant services for other than assistant at surgery
|
|
Physicians
|
|
Q5
|
Informal reciprocal arrangement (period not to exceed 14 continuous days)
|
|
Q6
|
Locum tenens or temporary arrangement (up to 90 days)
|
|
Radiologists
|
|
U6
|
CT, CTA, MRI, and MRA studies provided in the emergency department
|
|
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