List of Modifiers in Medical Billing (2021)

List of Modifiers in Medical Billing is a very important document and everyone who is working in the medical billing process should have the basic knowledge of these CPT Modifiers. We also called it CPT modifiers here CPT stands for Current Procedural Terminology.

Modifier definition in medical billing

CPT Modifiers are codes that are used to “Enhance or Alter The Description of service or Supply in Certain Condition”.

Definition of Modifier in Medical Billing

What is Modifiers in Medical Billing and Coding?

A CPT Modifier is a two-position alpha and alpha-numeric code used to identify certain situations that require the basic value of a procedure to be either enhanced or diminished. A modifier provides the means by which a service or procedure that has been performed can be altered without changing the procedures code. Modifying circumstances include. CPT Modifiers are an important part of the managed care system or medical billing.

  1. A service or procedure that has both a professional and technical component. (26 or TC)
  2. A service or procedure that was performed more than once on the same day by the same physician or by a different physician. (76 or 77)
  3. A bilateral procedure service that was performed. (50)
  4. A distinct procedure service. (59)

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Type of Modifiers in Medical Billing:

There are two types of modifiers A) Level 1 Modifier and B) Level 2 Modifier.

A- Level 1 modifiers are CPT modifiers containing 2  numeric digits. These modifiers administered by the American Medical Association.

B- HCPCS modifiers are called level 2 modifiers. It contains alpha or alphanumeric digits.

Modifiers list in Medical Billing:

There are different types of modifiers listed in medical billing and they are specified as per their uses like Anesthesia modifier, bilateral modifier, surgery modifier, etc. Description is mention below

List of Anesthesia Modifiers in Medical Billing –

These type of modifiers used with anesthesia procedure or CPT codes (00100- 01999)

Note- Anesthesia Services Billed by Anesthesiologist ( Do not use when the provider of service is Certified Registered Nurse Anesthetist-CRNA)

 Modifier AA -modifier used when service performed personally by an anesthesiologist.

 Modifier QY- Medical direction by one CRNA by an anesthesiologist

 Modifier QK- Medical direction of 2, 3, or 4 concurrent anesthesia procedures

Modifier AD– Medical supervision by a physician, more than four services is an anesthesiologist.

Modifier QS- Monitored Anesthesia Care(MAC)

Anesthesia Physical Status Modifiers:

These modifiers are informational purposes only.

Modifier P1-  A normal healthy patient.

Modifier P2-  A patient with mild systemic disease.

Modifier P3–  A patient with severe systemic disease.

Modifier P4– A patient with severe systemic disease that is a constant threat of life.

Modifier P5 –  A dying state patient who is not expected to survive without operation.

Modifier P6–  A declared brain dead patient whose organs being removed for donor purposes

Modifier G8– Monitored anesthesia care for deep complex, complicated, or markedly surgical procedures.

Modifier G9- Monitor anesthesia care for patient who has history of the severe cardiopulmonary condition.

List of Modifiers for Assistant Surgeon:

Medicare will make payment for an assistant at the surgery when the procedure is covered for an assistant and one of the following situations exists.

Modifier 80– Assistant Surgeon

Modifier 81– Minimum Assistant surgeon

Modifier 82– Assistant surgeon when qualified surgeon not present.

Modifier AS– Physician Assistant (PA), Clinical Nurse Specialist(CNS), Nurse Practioner (NP) for assistant surgery.

The allowed amount for assistant at surgery is 16% of physician fee schedule. For PA, CNS and NP allowed amount is 85% of 16% of physician fee schedule.

Bilateral Modifier:

Modifier 50– Bilateral means procedure performed in both sides RHS and LHS. Modifier 50 is used for bilateral procedures.

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Evaluation And Management(E/M)

The CPT Modifiers used with E/M codes are called E/M modifiers. E/M procedure codes range is 99201- 99499.

AI–  Principle physician of record. Effective from 01 January 2010. AI modifier is used by admitting or attending physician who oversees patient care. The principal physician of record shall append this modifier in addition to the initial visit code.

Modifier 24 Description– Unrelated E/M services by the same physician during the postoperative period.

Modifier 25 definition– Distinctive procedure.Significant, separately, identifiable E/M service by the same physician on the same day of the procedure.

Modifier 57– Decision of surgery. An E/M service that resulted in the initial decision to perform the surgery may be identified by adding modifier 57 to appropriate level of E/M service.

National Correct Coding Initiative(NCCI)

Modifier 59- As per the National Correct Coding Initiative(NCCI) CPT modifier 59 is distinct Procedure service. This modifier is used to indicate that the service updated with modifier 59 is distinct from other services performed on the same day.

Appropriate circumstances for using modifier 59-

  1. A different session or patient encounter.
  2. Different procedure or surgery
  3. Different site or organ system
  4. Separate incision/excision
  5. Separate lesion
  6. Separate injury

Modifiers for Repeat procedures:

Modifier 76- Repeat procedure or service by the same physician or other qualified healthcare professional. It may be necessary to indicate that procedure or service was repeated by the same physician or other qualified health professional subsequent to the original procedure or service.

Modifier 77- Repeat procedure by another physician or other qualified health care professional. It may be necessary to indicate that basic procedure or service was repeated by another physician or other qualified healthcare professional subsequent to the original procedure or service.

List of Surgical Modifiers

Modifier 51-  When multiple procedures, other than E/M services, physical medicine, and rehabilitation services or provision of supplies are performed at the same time by the same provider. The additional services other than primary procedure are appended by modifier 51.

Modifier 52-   Reduced services. Under certain circumstances, a service or procedure is partially reduced or elimininated at the physician’s direction. Medicare requires and operative report for surgical procedures and s concise statement as to how the reduced service is different from standard procedure. Claims for non surgical services reported with modifier 52 must contain a statement as to how the reduce service is different from standard service.

Modifier 53- Discontinued procedure. Under certain circumstances the physician may elect to terminate a surgical or diagnostic procedure. An operative report is required as well as a statement as to how much of the original procedure was accomplished.

Modifier 58-   Staged or related procedure or service by the same physician during the postoperative period. It is necessary to indicate that postoperative period was

  • Planned or Staged
  • More extensive than original procedure
  • For therapy following a surgical procedure.

Modifier 62- WhenTwo surgeons involved in the procedure. When 2 surgeons work together as primary surgeons performing distinct parts of procedure, each surgeon should report the distinct operative work adding the modifier 62 to the procedure code and any associated add on code for that procedures as long as both surgeons continue to work together primary surgeon.

Modifier 66-  Whenservices perform by surgical team.Under some circumstances, highly complex procedures are carried out under the “surgical team”. Such circumstances may be identified by each participating provider with the addition of modifier 66 to the basic procedure used for reporting services. In this case medicare requires operative report as well.

Modifier 78- Unplanned return to operating room by same physician or other qualified professional for related procedure during postoperative period. It may be necessary to indicate that another procedure was performed during the postoperative period of the initial procedure.

Modifier 79-  Unrelated procedure or service by the same physician during the postoperative period. The physician may need to indicate that the perform procedure during the postoperative period was unrelated to the original procedure.

List of HCPCS Modifiers A to Z (2021)

HCPCS is a short form of “Healthcare Common Procedural Coding System (HCPCS)”.

HCPCS ModifiersModifiers Description
A1Dressing for 1 wound
A2Dressing for 2 wounds
A3Dressing for 3 wounds
A4Dressing for 4 wounds
A5Dressing for 5 wounds
A6Dressing for 6 wounds
A7Dressing for 7 wounds
A8Dressing for 8 wounds
A9Dressing for 9 or more wounds
AAAnesthesia services performed personally by anesthesiologist
ADMedical supervision by a physician: more than four concurrent anesthesia procedures
AERegistered dietician
AFSpecialty physician
AGPrimary physician
AHClinical psychologist
AIPrincipal physician of record
AJClinical social worker
AKNon participating physician
AMPhysician, team member service
AOAlternate payment method declined by provider of service
APDetermination of refractive state was not performed in the course of diagnostic ophthalmological examination
AQPhysician providing a service in an unlisted health professional shortage area (hpsa)
ARPhysician provider services in a physician scarcity area
ASPhysician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery
ATAcute treatment (this modifier should be used when reporting service 98940, 98941, 98942, It is for Date of service on or after October 12, 2007. This modifier requires on all claims for tetanus and rabies)
AUItem furnished in conjunction with a urological, ostomy, or tracheostomy supply
AVItem furnished in conjunction with a prosthetic device, prosthetic or orthotic
AWItem furnished in conjunction with a surgical dressing
AXItem furnished in conjunction with dialysis services
AYItem or service furnished to an esrd patient that is not for the treatment of esrd
AZPhysician providing a service in a dental health professional shortage area for the purpose of an electronic health record incentive payment
B
BAItem furnished in conjunction with parenteral enteral nutrition (pen) services
BLSpecial acquisition of blood and blood products
BOOrally administered nutrition, not by feeding tube
BPThe beneficiary has been informed of the purchase and rental options and has elected to purchase the item
BRThe beneficiary has been informed of the purchase and rental options and has elected to rent the item
BUThe beneficiary has been informed of the purchase and rental options and after 30 days has not informed the supplier of his/her decision
C
CAProcedure payable only in the inpatient setting when performed emergently on an outpatient who expires prior to admission
CBService ordered by a renal dialysis facility (rdf) physician as part of the esrd beneficiary’s dialysis benefit, is not part of the composite rate, and is separately reimbursable
CCProcedure code change (use ‘cc’ when the procedure code submitted was changed either for administrative reasons or because an incorrect code was filed)
CDAmcc test has been ordered by an esrd facility or mcp physician that is part of the composite rate and is not separately billable
CEAmcc 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
CFAmcc test has been ordered by an esrd facility or mcp physician that is not part of the composite rate and is separately billable
CGPolicy criteria applied
CH0 percent impaired, limited or restricted
CIAt least 1 percent but less than 20 percent impaired, limited or restricted
CJAt least 20 percent but less than 40 percent impaired, limited or restricted
CKAt least 40 percent but less than 60 percent impaired, limited or restricted
CLAt least 60 percent but less than 80 percent impaired, limited or restricted
CMAt least 80 percent but less than 100 percent impaired, limited or restricted
CN100 percent impaired, limited or restricted
COOutpatient occupational therapy services furnished in whole or in part by an occupational therapy assistant
CPAdjunctive service related to a procedure assigned to a comprehensive ambulatory payment classification (c-apc) procedure, but reported on a different claim ((Terminated on 12/31/2017)
CQOutpatient physical therapy services furnished in whole or in part by a physical therapist assistant
CRCatastrophe/disaster related
CSCost-sharing waived for specified covid-19 testing-related services that result in and order for or administration of a covid-19 test and/or used for cost-sharing waived preventive services furnished via telehealth in rural health clinics and federally qualified health centers during the covid-19 public health emergency
CTComputed tomography services furnished using equipment that does not meet each of the attributes of the national electrical manufacturers association (nema) xr-29-2013 standard
E
E1Upper left, eyelid
E2Lower left, eyelid
E3Upper right, eyelid
E4Lower right, eyelid
EAErythropoetic stimulating agent (esa) administered to treat anemia due to anti-cancer chemotherapy
EBErythropoetic stimulating agent (esa) administered to treat anemia due to anti-cancer radiotherapy
ECErythropoetic stimulating agent (esa) administered to treat anemia not due to anti-cancer radiotherapy or anti-cancer chemotherapy
EDHematocrit 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
EEHematocrit 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
EJSubsequent claims for a defined course of therapy, e.g., epo, sodium hyaluronate, infliximab
EMEmergency reserve supply (for esrd benefit only)
EPService provided as part of medicaid early periodic screening diagnosis and treatment (epsdt) program
ERItems and services furnished by a provider-based, off-campus emergency department
ETEmergency services
EXExpatriate beneficiary
EYNo physician or other licensed health care provider order for this item or service
F
F1Left hand, 2nd digit
F2Left hand, 3rd digit
F3Left hand, 4th digit
F4Left hand, 5th digit
F5Right hand, thumb
F6Right hand, 2nd digit
F7Right hand, 3rd digit
F8Right hand, 4th digit
F9Right hand, 5th digit
FALeft hand, thumb
FBItem 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)
FCPartial credit received for replaced device
FPService provided as part of family planning program
FXX-ray taken using film
FYX-ray taken using computed radiography technology/cassette-based imaging
G
G0Telehealth services for diagnosis, evaluation, or treatment, of symptoms of an acute stroke
G1Most recent urr reading of less than 60
G2Most recent urr reading of 60 to 64.9
G3Most recent urr reading of 65 to 69.9
G4Most recent urr reading of 70 to 74.9
G5Most recent urr reading of 75 or greater
G6Esrd patient for whom less than six dialysis sessions have been provided in a month
G7Pregnancy resulted from rape or incest or pregnancy certified by physician as life threatening
G8Monitored anesthesia care (mac) for deep complex, complicated, or markedly invasive surgical procedure
G9Monitored anesthesia care for patient who has history of severe cardio-pulmonary condition
GAWaiver of liability statement issued as required by payer policy, individual case
GBClaim being re-submitted for payment because it is no longer covered under a global payment demonstration
GCThis service has been performed in part by a resident under the direction of a teaching physician
GDUnits of service exceeds medically unlikely edit value and represents reasonable and necessary services (Terminated on 12/31/2019)
GEThis service has been performed by a resident without the presence of a teaching physician under the primary care exception
GFNon-physician (Ex. nurse practitioner (np), certified registered nurse anesthetist (crna), certified registered nurse (crn), clinical nurse specialist (cns), physician assistant (pa)) services in a critical access hospital
GGPerformance and payment of a screening mammogram and diagnostic mammogram on the same patient, same day
GHDiagnostic mammogram converted from screening mammogram on same day
GJ“opt out” physician or practitioner emergency or urgent service
GKReasonable and necessary item/service associated with a ga or gz modifier
GLMedically unnecessary upgrade provided instead of non-upgraded item, no charge, no advance beneficiary notice (abn)
GMMultiple patients on one ambulance trip
GNServices delivered under an outpatient speech language pathology plan of care
GOServices delivered under an outpatient occupational therapy plan of care
GPServices delivered under an outpatient physical therapy plan of care
GQVia asynchronous telecommunications system
GRThis 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
GSDosage of erythropoietin stimulating agent has been reduced and maintained in response to hematocrit or hemoglobin level
GTVia interactive audio and video telecommunication systems
GUWaiver of liability statement issued as required by payer policy, routine notice
GVAttending physician not employed or paid under arrangement by the patient’s hospice provider
GWService not related to the hospice patient’s terminal condition
GXNotice of liability issued, voluntary under payer policy
GYItem or service statutorily excluded, does not meet the definition of any medicare benefit or, for non-medicare insurers, is not a contract benefit
GZItem or service expected to be denied as not reasonable and necessary
H
H9Court-ordered
HAChild/adolescent program
HBAdult program, non geriatric
HCAdult program, geriatric
HDPregnant/parenting women’s program
HEMental health program
HFSubstance abuse program
HGOpioid addiction treatment program
HHIntegrated mental health/substance abuse program
HIIntegrated mental health and intellectual disability/developmental disabilities program
HJEmployee assistance program
HKSpecialized mental health programs for high-risk populations
HLIntern
HMLess than bachelor degree level
HNBachelors degree level
HOMasters degree level
HPDoctoral level
HQGroup setting
HRFamily/couple with client present
HSFamily/couple without client present
HTMulti-disciplinary team
HUFunded by child welfare agency
HVFunded state addictions agency
HWFunded by state mental health agency
HXFunded by county/local agency
HYFunded by juvenile justice agency
HZFunded by criminal justice agency
J
J1Competitive acquisition program no-pay submission for a prescription number
J2Competitive acquisition program, restocking of emergency drugs after emergency administration
J3Competitive acquisition program (cap), drug not available through cap as written, reimbursed under average sales price methodology
J4Dmepos item subject to dmepos competitive bidding program that is furnished by a hospital upon discharge
J5Off-the-shelf orthotic subject to dmepos competitive bidding program that is furnished as part of a physical therapist or occupational therapist professional service
JAAdministered intravenously
JBAdministered subcutaneously
JCSkin substitute used as a graft
JDSkin substitute not used as a graft
JEAdministered via dialysate
JFCompounded drug Terminated on 06/30/2015
JGDrug or biological acquired with 340b drug pricing program discount
JWDrug amount discarded/not administered to any patient
K
K0Lower extremity prosthesis functional level 0 – does not have the ability or potential to ambulate or transfer safely with or without assistance and a prosthesis does not enhance their quality of life or mobility.
K1Lower extremity prosthesis functional level 1 – has the ability or potential to use a prosthesis for transfers or ambulation on level surfaces at fixed cadence. typical of the limited and unlimited household ambulator.
K2Lower extremity prosthesis functional level 2 – has the ability or potential for ambulation with the ability to traverse low level environmental barriers such as curbs, stairs or uneven surfaces. typical of the limited community ambulator.
K3Lower extremity prosthesis functional level 3 – has the ability or potential for ambulation with variable cadence. typical of the community ambulator who has the ability to transverse most environmental barriers and may have vocational, therapeutic, or exercise activity that demands prosthetic utilization beyond simple locomotion.
K4Lower extremity prosthesis functional level 4 – has the ability or potential for prosthetic ambulation that exceeds the basic ambulation skills, exhibiting high impact, stress, or energy levels, typical of the prosthetic demands of the child, active adult, or athlete.
KAAdd on option/accessory for wheelchair
KBBeneficiary requested upgrade for abn, more than 4 modifiers identified on claim
KCReplacement of special power wheelchair interface
KDDrug or biological infused through dme
KEBid under round one of the dmepos competitive bidding program for use with non-competitive bid base equipment
KFItem designated by fda as class iii device
KGDmepos item subject to dmepos competitive bidding program number 1
KHDmepos item, initial claim, purchase or first month rental
KIDmepos item, second or third month rental
KJDmepos item, parenteral enteral nutrition (pen) pump or capped rental, months four to fifteen
KKDmepos item subject to dmepos competitive bidding program number 2
KLDmepos item delivered via mail
KMReplacement of facial prosthesis including new impression/moulage
KNReplacement of facial prosthesis using previous master model
KOSingle drug unit dose formulation
KPFirst drug of a multiple drug unit dose formulation
KQSecond or subsequent drug of a multiple drug unit dose formulation
KRRental item, billing for partial month
KSGlucose monitor supply for diabetic beneficiary not treated with insulin
KTBeneficiary resides in a competitive bidding area and travels outside that competitive bidding area and receives a competitive bid item
KUDmepos item subject to dmepos competitive bidding program number 3
KVDmepos item subject to dmepos competitive bidding program that is furnished as part of a professional service
KWDmepos item subject to dmepos competitive bidding program number 4
KXRequirements specified in the medical policy have been met
KYDmepos item subject to dmepos competitive bidding program number 5
KZNew coverage not implemented by managed care
L
L1Provider attestation that the hospital laboratory test(s) is not packaged under the hospital opps (Terminated on 21/31/2016)
LCLeft circumflex coronary artery
LDLeft anterior descending coronary artery
LLLease/rental (use the ‘ll’ modifier when dme equipment rental is to be applied against the purchase price)
LMLeft main coronary artery
LRLaboratory round trip
LSFda-monitored intraocular lens implant
LTLeft side (used to identify procedures performed on the left side of the body)
M
M2Medicare secondary payer (msp)
MAOrdering professional is not required to consult a clinical decision support mechanism due to service being rendered to a patient with a suspected or confirmed emergency medical condition
MBOrdering professional is not required to consult a clinical decision support mechanism due to the significant hardship exception of insufficient internet access
MCOrdering professional is not required to consult a clinical decision support mechanism due to the significant hardship exception of electronic health record or clinical decision support mechanism vendor issues
MDOrdering professional is not required to consult a clinical decision support mechanism due to the significant hardship exception of extreme and uncontrollable circumstances
METhe order for this service adheres to appropriate use criteria in the clinical decision support mechanism consulted by the ordering professional
MFThe order for this service does not adhere to the appropriate use criteria in the clinical decision support mechanism consulted by the ordering professional
MGThe order for this service does not have applicable appropriate use criteria in the qualified clinical decision support mechanism consulted by the ordering professional
MHUnknown if ordering professional consulted a clinical decision support mechanism for this service, related information was not provided to the furnishing professional or provider
MSSix month maintenance and servicing fee for reasonable and necessary parts and labor which are not covered under any manufacturer or supplier warranty
N
NBNebulizer system, any type, fda-cleared for use with specific drug
NRNew when rented (use the ‘nr’ modifier when dme which was new at the time of rental is subsequently purchased)
NUNew equipment
P
P1A normal healthy patient
P2A patient with mild systemic disease
P3A patient with severe systemic disease
P4A patient with severe systemic disease that is a constant threat to life
P5A moribund patient who is not expected to survive without the operation
P6A declared brain-dead patient whose organs are being removed for donor purposes
PASurgical or other invasive procedure on wrong body part
PBSurgical or other invasive procedure on wrong patient
PCWrong surgery or other invasive procedure on patient
PDDiagnostic 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
PIPositron emission tomography (pet) or pet/computed tomography (ct) to inform the initial treatment strategy of tumors that are biopsy proven or strongly suspected of being cancerous based on other diagnostic testing
PLProgressive addition lenses
PMPost mortem
PNNon-excepted service provided at an off-campus, outpatient, provider-based department of a hospital
POExcepted service provided at an off-campus, outpatient, provider-based department of a hospital
PSPositron emission tomography (pet) or pet/computed tomography (ct) to inform the subsequent treatment strategy of cancerous tumors when the beneficiary’s treating physician determines that the pet study is needed to inform subsequent anti-tumor strategy
PTColorectal cancer screening test; converted to diagnostic test or other procedure
Q
Q0Investigational clinical service provided in a clinical research study that is in an approved clinical research study
Q1Routine clinical service provided in a clinical research study that is in an approved clinical research study
Q2Demonstration procedure/service
Q3Live kidney donor surgery and related services
Q4Service for ordering/referring physician qualifies as a service exemption
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
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
Q7One class a finding
Q8Two class b findings
Q9One class b and two class c findings
QAPrescribed amounts of stationary oxygen for daytime use while at rest and nighttime use differ and the average of the two amounts is less than 1 liter per minute (lpm)
QBPrescribed amounts of stationary oxygen for daytime use while at rest and nighttime use differ and the average of the two amounts exceeds 4 liters per minute (lpm) and portable oxygen is prescribed
QCSingle channel monitoring
QDRecording and storage in solid state memory by a digital recorder
QEPrescribed amount of stationary oxygen while at rest is less than 1 liter per minute (lpm)
QFPrescribed amount of stationary oxygen while at rest exceeds 4 liters per minute (lpm) and portable oxygen is prescribed
QGPrescribed amount of stationary oxygen while at rest is greater than 4 liters per minute (lpm)
QHOxygen conserving device is being used with an oxygen delivery system
QJServices/items provided to a prisoner or patient in state or local custody, however the state or local government, as applicable, meets the requirements in 42 cfr 411.4 (b)
QKMedical direction of two, three, or four concurrent anesthesia procedures involving qualified individuals
QLPatient pronounced dead after ambulance called
QMAmbulance service provided under arrangement by a provider of services
QNAmbulance service furnished directly by a provider of services
QPDocumentation is on file showing that the laboratory test(s) was ordered individually or ordered as a cpt-recognized panel other than automated profile codes 80002-80019, g0058, g0059, and g0060.
QQOrdering professional consulted a qualified clinical decision support mechanism for this service and the related data was provided to the furnishing professional
QRPrescribed amounts of stationary oxygen for daytime use while at rest and nighttime use differ and the average of the two amounts is greater than 4 liters per minute (lpm)
QSMonitored anesthesia care service
QTRecording and storage on tape by an analog tape recorder
QWClia waived test
QXCrna service: with medical direction by a physician
QYMedical direction of one certified registered nurse anesthetist (crna) by an anesthesiologist
QZCrna service: without medical direction by a physician
R
RAReplacement of a dme, orthotic or prosthetic item
RBReplacement of a part of a dme, orthotic or prosthetic item furnished as part of a repair
RCRight coronary artery
RDDrug provided to beneficiary, but not administered “incident-to”
REFurnished in full compliance with fda-mandated risk evaluation and mitigation strategy (rems)
RIRamus intermedius coronary artery
RRRental (use the ‘rr’ modifier when dme is to be rented)
RTRight side (used to identify procedures performed on the right side of the body)
S
SANurse practitioner rendering service in collaboration with a physician
SBNurse midwife
SCMedically necessary service or supply
SDServices provided by registered nurse with specialized, highly technical home infusion training
SEState and/or federally-funded programs/services
SFSecond opinion ordered by a professional review organization (pro) per section 9401, p.l. 99-272 (100% reimbursement – no medicare deductible or coinsurance)
SGAmbulatory surgical center (asc) facility service
SHSecond concurrently administered infusion therapy
SJThird or more concurrently administered infusion therapy
SKMember of high risk population (use only with codes for immunization)
SLState supplied vaccine
SMSecond surgical opinion
SNThird surgical opinion
SQItem ordered by home health
SSHome infusion services provided in the infusion suite of the iv therapy provider
STRelated to trauma or injury
SUProcedure performed in physician’s office (to denote use of facility and equipment)
SVPharmaceuticals delivered to patient’s home but not utilized
SWServices provided by a certified diabetic educator
SYPersons who are in close contact with member of high-risk population (use only with codes for immunization)
SZHabilitative services (Terminated on 12/31/2017)
.
T
T1Left foot, 2nd digit
T2Left foot,3rd digit
T3Left foot,4th digit
T4Left foot, 5th digit
T5Right foot, great toe
T6Right foot, 2nd digit
T7Right foot, 3rd digit
T8Right foot, 4th digit
T9Right foot, 5th digit
TALeft foot, great toe
TBDrug or biological acquired with 340b drug pricing program discount, reported for informational purposes
TCTechnical 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 number; technical component charges are institutional charges and not billed separately by physicians; however, portable x-ray suppliers only bill for technical component and should utilize modifier tc; the charge data from portable x-ray suppliers will then be used to build customary and prevailing profiles.
TDRn
TELpn/lvn
TFIntermediate level of care
TGComplex/high tech level of care
THObstetrical treatment/services, prenatal or postpartum
TJProgram group, child and/or adolescent
TKExtra patient or passenger, non-ambulance
TLEarly intervention/individualized family service plan (ifsp)
TMIndividualized education program (iep)
TNRural/outside providers’ customary service area
TPMedical transport, unloaded vehicle
TQBasic life support transport by a volunteer ambulance provider
TRSchool-based individualized education program (iep) services provided outside the public school district responsible for the student
TSFollow-up service
TTIndividualized service provided to more than one patient in same setting
TUSpecial payment rate, overtime
TVSpecial payment rates, holidays/weekends
TWBack-up equipment
U
U1Medicaid level of care 1,As per every state guidelines and definition
U2Medicaid level of care 2,As per every state guidelines and definition
U3Medicaid level of care 3,As per every state guidelines and definition
U4Medicaid level of care 4,As per every state guidelines and definition
U5Medicaid level of care 5,As per every state guidelines and definition
U6Medicaid level of care 6,As per every state guidelines and definition
U7Medicaid level of care 7,As per every state guidelines and definition
U8Medicaid level of care 8,As per every state guidelines and definition
U9Medicaid level of care 9,As per every state guidelines and definition
UAMedicaid level of care 10,As per every state guidelines and definition
UBMedicaid level of care 11,As per every state guidelines and definition
UCMedicaid level of care 12,As per every state guidelines and definition
UDMedicaid level of care 13,As per every state guidelines and definition
UEUsed durable medical equipment
UFServices provided in the morning
UGServices provided in the afternoon
UHServices provided in the evening
UJServices provided at night
UKServices provided on behalf of the client to someone other than the client (collateral relationship)
UNTwo patients served
UPThree patients served
UQFour patients served
URFive patients served
USSix or more patients served
V
V1Demonstration modifier 1
V2Demonstration modifier 2
V3Demonstration modifier 3
V4Demonstration modifier 4
V5Vascular catheter (alone or with any other vascular access)
V6Arteriovenous graft (or other vascular access not including a vascular catheter)
V7Arteriovenous fistula only (in use with two needles)
V8Infection present ( This modifier Terminated on March 31, 2012)
V9No infection present ( This modifier Terminated on March 31, 2012)
VMMedicare diabetes prevention program (mdpp) virtual make-up session
VPAphakic patient
X
X1Continuous/broad services: for reporting services by clinicians, who provide the principal care for a patient, with no planned endpoint of the relationship; services in this category represent comprehensive care, dealing with the entire scope of patient problems, either directly or in a care coordination role; reporting clinician service examples include, but are not limited to: primary care, and clinicians providing comprehensive care to patients in addition to specialty care
X2Continuous/focused services: for reporting services by clinicians whose expertise is needed for the ongoing management of a chronic disease or a condition that needs to be managed and followed with no planned endpoint to the relationship; reporting clinician service examples include but are not limited to: a rheumatologist taking care of the patient’s rheumatoid arthritis longitudinally but not providing general primary care services
X3Episodic/broad servies: for reporting services by clinicians who have broad responsibility for the comprehensive needs of the patient that is limited to a defined period and circumstance such as a hospitalization; reporting clinician service examples include but are not limited to the hospitalist’s services rendered providing comprehensive and general care to a patient while admitted to the hospital
X4Episodic/focused services: for reporting services by clinicians who provide focused care on particular types of treatment limited to a defined period and circumstance; the patient has a problem, acute or chronic, that will be treated with surgery, radiation, or some other type of generally time-limited intervention; reporting clinician service examples include but are not limited to, the orthopedic surgeon performing a knee replacement and seeing the patient through the postoperative period
X5Diagnostic services requested by another clinician: for reporting services by a clinician who furnishes care to the patient only as requested by another clinician or subsequent and related services requested by another clinician; this modifier is reported for patient relationships that may not be adequately captured by the above alternative categories; reporting clinician service examples include but are not limited to, the radiologist’s interpretation of an imaging study requested by another clinician
XESeparate encounter, a service that is distinct because it occurred during a separate encounter
XPSeparate practitioner, a service that is distinct because it was performed by a different practitioner
XSSeparate structure, a service that is distinct because it was performed on a separate organ/structure
XUUnusual non-overlapping service, the use of a service that is distinct because it does not overlap usual components of the main service
Z
ZANovartis/sandoz (Terminated on 03/31/2018)
ZBPfizer/hospira  (Terminated on 03/31/2018)
ZCMerck/samsung bioepis  (Terminated on 03/31/2018)

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CPT Range and Accepted Modifiers List in Medical Billing

Type Of Service CPT Code RangeAccepted Modifiers
Anesthesia00100 — 01999AA
Surgery10000 — 6999922, 50, 51, 62, 80, 81, 59, 78, 79
Radiology70010 — 7999922, 52, 26, 76, 77
LAB Codes80000 — 89999QW
Medicine90701 — 9919926
E/M Codes99201 — 9949925

List of Modifiers for Medical Billing Used in Daily Claims:

CPT Modifiers are also playing an important role to reduce the denials also. Using the correct modifier is to reduce the claims defect and increase the clean claim rate also. The updated list of modifiers for medical billing is mention below

S.N.ModifierDescription
1Modifier 22Unusual procedure
2Modifier 23Unusual Anesthesia
3Modifier 24Unrelated E/M service
4Modifier 25Separate or distinct or Bundled E/M service
5Modifier 26Professional Component
6Modifier 32Mandatory Services
7Modifier 33Preventive Services
8Modifier 50Bilateral Services (Both Side)
9Modifier 51Multiple Procedure
10Modifier 52Reduced Services
11Modifier 53Discontinued Procedure
12Modifier 54Surgical care Only
13Modifier 55Postoperative Management
14Modifier 56Preoperative Management
15Modifier 57Decision of Surgery
16Modifier 58Staged or related Procedure
17Modifier 59Bundled Service
18Modifier 76Repeat procedure, same provider
19Modifier 77Repeat procedure, different provider
20Modifier 78Unplanned return to operating room during postoperative care, related procedure by the same provider.
21Modifier 79 Unplanned return to the operating room during postoperative care, unrelated procedure by same provider.
22Modifier 80Assistant Surgeon
23Modifier 81Minimum Assistant Surgeon
24Modifier 82Assistant Surgeon when qualified surgeon not present.
25Modifier 99Multiple Modifiers
26Modifier GWProcedure not related to patients’ Hospice condition.
27Modifier QWCLAIA Wave Test- Lab Test
28Modifier TCTechnical Component

List of modifiers in medical billing are mostly not updated every year but if we will get new updates on modifiers, update this list.

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