Medical billing modifiers

A modifier is a two-character code (numeric or alphanumeric) added to a CPT or HCPCS procedure code. It gives extra information about the service performed without changing the code’s basic definition.

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87 modifiers

General and E/M

24: Unrelated E/M service by the same physician during a postoperative period.
25: Separately identifiable E/M service on the same day.
26: Professional component (physician’s interpretation only).
32: Mandated services (e.g., by court, insurance or any governmental agency).
33: Used to indicate that a service was provided as a preventive measure.
93: Synchronous telemedicine service delivered through a real-time, audio-only system.
95: Synchronous telemedicine service.
99: Multiple modifiers (used when more than 4 modifiers are needed to describe the service completely).
GA: Waiver of liability statement issued as required by payer policy (an ABN is on file).
GN: Services delivered under an outpatient speech-language pathology plan of care.
GO: Services delivered under an outpatient occupational therapy plan of care.
GP: Services delivered under an outpatient physical therapy plan of care.
GQ: Telehealth service delivered through an asynchronous (store-and-forward) system.
GT: Telehealth service delivered through interactive audio and video.
GY: Item or service that is statutorily excluded or does not meet the definition of a Medicare benefit.
GZ: Item or service expected to be denied as not reasonable and necessary (no ABN on file).
JW: Drug amount discarded or not administered to any patient.
JZ: Zero drug amount discarded or not administered to any patient.
KX: Requirements specified in the medical policy have been met.
TC: Technical component (equipment, supplies and staff; not the physician’s interpretation).

Surgery and procedures

22: Increased procedural services.
50: Bilateral procedure (performed on both sides of the body).
51: Multiple surgical or procedure services performed by the same individual during the same operative session.
52: Procedure or service partially reduced or terminated at the physician’s discretion.
53: Discontinued procedure. Used when a surgical or diagnostic procedure is started but terminated due to extenuating circumstances or conditions that threaten the patient’s health.
54: Surgical care only.
55: Postoperative management only.
56: Preoperative management only.
57: Decision for surgery.
58: Staged or related procedure or service performed by the same physician during the postoperative period of an initial procedure.
62: Two surgeons performed services collectively.
66: Surgical team.
76: Repeat procedure by the same physician on the same day.
77: Repeat procedure by another physician on the same day.
78: Unplanned return of the patient.
79: Unrelated procedure or service by the same physician during the postoperative period.
80: Assistant surgeon.
81: Minimum assistant surgeon.
82: Assistant surgeon (when a qualified resident is not available).

Anesthesia

23: Unusual anesthesia.
47: Anesthesia by surgeon.
AA: Anesthesia services personally performed by the anesthesiologist.
AD: Medical supervision by a physician, more than four concurrent procedures.
QK: Medical direction of 2–4 concurrent anesthesia procedures by a physician.
QX: CRNA (Certified Registered Nurse Anesthetist) service with medical direction by a physician.
QY: Medical direction of one CRNA (Certified Registered Nurse Anesthetist) by a physician.
QZ: CRNA (Certified Registered Nurse Anesthetist) service without medical direction.

Laboratory

90: Reference (outside) laboratory.
91: Repeat clinical diagnostic lab test.
92: Alternative lab platform testing.

Ambulance

RH: Ambulance service from residence to hospital.
NH: Ambulance service from nursing home to hospital.
SH: Ambulance service from scene to hospital.

Distinct and separate services

59: Procedure or service was distinct or independent from other services performed on the same day.
XE: Separate encounter.
XS: Separate structure.
XP: Separate practitioner.
XU: Unusual non-overlapping service.

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Modifiers