Friday, July 22, 2016

Medicare part B modifiers full list

Modifiers to be used for Part B


Program Category Modifier Code Description
PART - B Physician Quality Reporting 1P Physician Quality Reporting System – Performance measure exclusion modifier due to medical reasons.
PART - B Surgical 22 Unusual procedural services.
PART - B E/M 24 Evaluation and Management (E/M) – Unrelated E/M service by the same physician during a postoperative period.
PART - B E/M 25 Significant, separately identifiable Evaluation and Management (E/M) service by the same physician on the same day of the procedure or other service.
PART - B Radiology/Pathology 26 Professional component.
PART - B Physician Quality Reporting 2P Physician Quality Reporting System  – Performance measure exclusion modifier due to patient reasons.
PART - B Physician Quality Reporting 3P Physician Quality Reporting System  – Performance measure exclusion modifier due to system reasons.
PART - B Coding 50 Bilateral procedure.
PART - B Surgical 51 Multiple procedures.
PART - B Coding 52 Reduced services.
PART - B Coding 53 Discontinued procedure. 
PART - B Surgical 54 Surgical care only.
PART - B Surgical 55 Postoperative management only.
PART - B Surgical 56 Preoperative management only.
PART - B E/M 57 Evaluation and Management (E/M) – Decision for surgery.
PART - B Surgical 58 Staged or related procedure or service by the same physician during the postoperative period.
PART - B Coding 59 National Correct Coding Initiative (NCCI) – Distinct procedural service.
PART - B Surgical 62 Two surgeons.
PART - B Surgical 66 Surgical team.
PART - B ASC 73 Ambulatory Surgical Center (ASC) – Discontinued procedure prior to administration of anesthesia.
PART - B ASC 74 Ambulatory Surgical Center (ASC) – Discontinued procedure after administration of anesthesia.
PART - B Coding 76 Repeat procedure by same physician. 
PART - B Coding 77 Repeat procedure by another physician. 
PART - B Surgical 78 Return to the operative room for a related procedure during the postoperative period.
PART - B Surgical 79 Unrelated procedure or service by the same physician during the postoperative period.
PART - B Surgical 80 Assistant surgeon.
PART - B Surgical 81 Minimum assistant surgeon.
PART - B Surgical 82 Assistant surgeon (when qualified resident surgeon not available).
PART - B Physician Quality Reporting  8P Physician Quality Reporting System – Performance measure reporting modifier – action not performed, reason not otherwise specified.
PART - B Laboratory 90 Referenced (outside) laboratory.
PART - B Laboratory 91 Repeat clinical diagnostic laboratory test.
PART - B Coding 99 Multiple modifiers.
PART - B Anesthesia AA Services performed personally by an anesthesiologist.
PART - B Anesthesia AD Medical supervision by a physician, more than four concurrent procedures.
PART - B Psychiatric  AH Clinical psychologist.
PART - B E/M AI Principal physician of record.
PART - B Psychiatric  AJ Clinical social worker.
PART - B HPSA/PSA AQ Physician providing a service in a Health Professional Shortage Area (HPSA).
PART - B HPSA/PSA AR Physician provided service in a Physician Scarcity Area (PSA).
PART - B Surgical AS Physician Assistant (PA), Clinical Nurse Specialist (CNS) or Nurse Practitioner (NP) services for assistant-at-surgery.
PART - B Chiropractic AT Acute treatment.
PART - B Outpatient Hospital AY Item or service furnished to an ESRD patient that is not for the treatment of ESRD.
PART - B Health Professional Shortage Area (HPSA) AZ Physician providing a service in a dental health professional shortage area for the purpose of an Electronic Health Record (EHR) incentive payment.
PART - B ESRD CB Service ordered by a RDF physician as part End Stage Renal Disease (ESRD) beneficiary’s dialysis benefit.
PART - B Coding CC Procedure code change.
PART - B Catastrophe/Disaster CR Catastrophe/Disaster-related claims.
PART - B Disaster-related claims CS Gulf oil spill 2010 related.
PART - B Anatomical E1 Upper left eyelid.
PART - B Anatomical E2 Lower left eyelid.
PART - B Anatomical E3 Upper right eyelid.
PART - B Anatomical E4 Lower right eyelid.
PART - B Drugs EA Erythropoiesis Stimulating Agent (ESA) – Anemia, chemo-induced.
PART - B Drugs EB Erythropoiesis Stimulating Agent (ESA) – Anemia, radio-induced.
PART - B Drugs EC Erythropoiesis Stimulating Agent (ESA) – Anemia, non-chemo/radio.
PART - B Anatomical F1 Left hand, second digit.
PART - B Anatomical F2 Left hand, third digit.
PART - B Anatomical F3 Left hand, fourth digit.
PART - B Anatomical F4 Left hand, fifth digit.
PART - B Anatomical F5 Right hand, thumb.
PART - B Anatomical F6 Right hand, second digit.
PART - B Anatomical F7 Right hand, third digit.
PART - B Anatomical F8 Right hand, fourth digit.
PART - B Anatomical F9 Right hand, fifth digit.
PART - B Anatomical FA Left hand, thumb.
PART - B ASC FB Ambulatory Surgical Center (ASC) – Item provided without cost to provider, supplier or practitioner, or full credit received for replaced device.
PART - B ASC FC Ambulatory Surgical Center (ASC) – Partial credit received for replaced device.
PART - B Anesthesia G8 Monitored Anesthesia Care (MAC) for deep complex, complicated or markedly invasive surgical procedure.
PART - B Anesthesia G9 Monitored Anesthesia Care (MAC) for patient who has history of severe cardiopulmonary condition.
PART - B ABN GA Waiver of liability statement issued, as required by payer policy.
PART - B Resident GC Service performed in part by a resident under the direction of a teaching physician.
PART - B Resident GE Service performed by a resident without the presence of a teaching physician under the primary care exception.
PART - B Radiology GG Performance and payment of a screening mammography and diagnostic mammography on the same patient, same day.
PART - B Opt-Out GJ “Opt-Out” physician or practitioner service provided in an emergency or urgent service.
PART - B Ambulance GM Multiple patients on one ambulance trip.
PART - B PT/OT GN Physical/Occupational Therapy (PT/OT) – Services delivered under an outpatient speech language pathology plan of care.
PART - B PT/OT GO Physical/Occupational Therapy (PT/OT) – Services delivered under an outpatient occupational therapy plan of care.
PART - B PT/OT GP Physical/Occupational Therapy (PT/OT) – Services delivered under an outpatient physical therapy plan of care.
PART - B Telehealth GT Via interactive audio and video telecommunications system.
PART - B Hospice GV Attending physician not employed or paid under arrangement by the patient’s hospice provider. 
PART - B Hospice GW Service not related to the hospice patient’s terminal condition.
PART - B Excluded GY Item or service statutorily excluded or does not meet the definition of any Medicare benefit.
PART - B ABN GZ Advance Beneficiary Notice (ABN) was not signed by the beneficiary.
PART - B CAP J1 “No pay” Competitive Acquisition Program (CAP)modifier for drug line.
PART - B CAP J2 Competitive Acquisition Program (CAP) emergency re-supply.
PART - B CAP J3 Competitive Acquisition Program (CAP) “Furnish as Written.”
PART - B Drugs JW Drug amount discarded/not administered to any patient.
PART - B Drugs  KD Drug or biological infused through Durable Medical Equipment (DME). 
PART - B Medical Policy KX Requirements specified in the medical policy have been met.
PART - B Anatomical LC Left circumflex coronary artery.
PART - B Anatomical LD Left anterior descending coronary artery.
PART - B Laboratory LR Laboratory round trip.
PART - B Eye LS FDA-monitored Intraocular Lens (IOL) implant.
PART - B Anatomical LT Left side.
PART - B CAP MS Competitive Acquisition Program (CAP) Medicare secondary payer.
PART - B Anesthesia P1 Physical Status – A normal healthy patient.
PART - B Anesthesia  P2 Physical Status – A patient with mild systemic disease.
PART - B Anesthesia  P3 Physical Status – A patient with severe systemic disease.
PART - B Anesthesia  P4 Physical Status – A patient with severe systemic disease that is a constant threat to life.
PART - B Anesthesia  P5 Physical Status – A moribund patient who is not expected to survive without the operation.
PART - B Anesthesia  P6 Physical Status – A declared brain-dead patient whose organs are being removed for donor purposes.
PART - B Wrong Procedure PA Surgery wrong body part. Wrong surgical or other invasive procedures performed on a patient.
PART - B Wrong Procedure PB Surgery wrong patient. Wrong surgical or other invasive procedures performed on a patient
PART - B Wrong Procedure PC Wrong surgery on patient. Wrong surgical or other invasive procedures performed on a patient.
PART - B Radiology PI Positron Emission Tomography (PET) or PET/Computed Tomography (CT).
PART - B Radiology PS Positron Emission Tomography (PET) or PET/Computed Tomography (CT).
PART - B Surgical PT Colorectal cancer screening test; converted to diagnostic test or other procedure.
PART - B Clinical Research Studies Q0 Investigational clinical service provided in a clinical research study that is in an approved clinical research study.
PART - B Clinical Research Studies Q1 Routine clinical service provided in a clinical research study that is in an approved clinical research study.
PART - B Kidney Q3 Live kidney donor surgery and related services.
PART - B Physician Q5 Service furnished by a substitute physician under a reciprocal billing arrangement.
PART - B Physician Q6 Services furnished by a locum tenens physician.
PART - B Footcare Q7 One class A finding.
PART - B Footcare Q8 Two class B findings.
PART - B Footcare Q9 One class B and two class C findings.
PART - B Prison/Custody QJ Services/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).        For outpatient claims, providers should append modifier QJ on all lines with a line item date of service during the incarceration period. All associated charges should be billed as non-covered.
PART - B Anesthesia QK Medical direction of two, three or four concurrent procedures.
PART - B Ambulance QL Patient pronounced dead after ambulance called (do not use origin and destination modifiers, only QL).
PART - B Anesthesia QS Monitored Anesthesia Care (MAC) services.
PART - B Laboratory QW Clinical Laboratory Improvement Amendments (CLIA) waived test.
PART - B Anesthesia QX Certified Registered Nurse Anesthetist (CRNA) service with medical direction by a physician.
PART - B Anesthesia QY Medical direction of one Certified Registered Nurse Anesthetist (CRNA) by an anesthesiologist.
PART - B Anesthesia QZ Certified Registered Nurse Anesthetist (CRNA) service without medical direction by a physician.
PART - B DME RA Replacement of a Durable Medical Equipment (DME), orthotic or prosthetic item.
PART - B Anatomical RC Right coronary artery.
PART - B Anatomical RT Right side.
PART - B ASC SG Ambulatory Surgical Center (ASC) – Facility service.
PART - B Anatomical T1 Left foot, second digit.
PART - B Anatomical T2 Left foot, third digit.
PART - B Anatomical T3 Left foot, fourth digit.
PART - B Anatomical T4 Left foot, fifth digit.
PART - B Anatomical T5 Right foot, great toe.
PART - B Anatomical T6 Right foot, second digit.
PART - B Anatomical T7 Right foot, third digit.
PART - B Anatomical T8 Right foot, fourth digit.
PART - B Anatomical T9 Right foot, fifth digit.
PART - B Anatomical TA Left foot, great toe.
PART - B Radiology/Pathology TC Technical component.
PART - B Radiology UN Portable X-Ray Supplier – Two patients served.
PART - B Radiology UP Portable X-Ray Supplier – Three patients served.
PART - B Radiology UQ Portable X-Ray Supplier – Four patients served.
PART - B Radiology UR Portable X-Ray Supplier – Five patients served.
PART - B Radiology US Portable X-Ray Supplier – Six patients served.

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