MODIFIERS APPROVED FOR AMBULATORY SURGERY CENTER (ASC) HOSPITAL OUTPATIENT USE

25 Significant, Separately Identifiable Evaluation and Management Service by the Same Physician on the
Same Day of the Procedure or Other Service
27 Multiple Outpatient Hospital E/M Encounters on the Same Date
50 Bilateral Procedure
52 Reduced Services
58 Staged or Related Procedure or Service by the Same Physician During the Postoperative Period
59 Distinct Procedural Service
73 Discontinued Out-Patient Hospital/Ambulatory Surgery Center (ASC) Procedure Prior to the
Administration of Anesthesia
74 Discontinued Out-Patient Hospital/Ambulatory Surgery Center (ASC) Procedure After Administration
of Anesthesia
76 Repeat Procedure by Same Physician
77 Repeat Procedure by Another Physician
78 Return to the Operating Room for a Related Procedure During the Postoperative Period
79 Unrelated Procedure or Service by the Same Physician During the Postoperative Period

Level II (HCPCS/National) Modifiers

E1 Upper left, eyelid
E2 Lower left, eyelid
E3 Upper right, eyelid
E4 Lower right, eyelid
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
FA Left hand, thumb
GA Waiver of Liability on file
GC Resident/Teaching Physician Service
GE Resident Primary Care Exception
GV Attending Physician not hospice
GW Service unrelated to terminal condition
LC Left circumflex coronary artery (Hospitals use with
codes 92980-92984, 92995, 92996)
LD Left anterior descending coronary artery (Hospitals
use with codes 92980-92984, 92995, 92996)
LT Left side (used to identify procedures performed on
the left side of the body)
QM Ambulance service provided under arrangement by
a provider of services
RC Right coronary artery (Hospitals use with codes
92980-92984, 92995, 92996)
RT Right side (used to identify procedures performed
on the right side of the body)
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
TA Left foot, great toe