Friday, July 22, 2016

Medicare part A modifiers full list

Modifiers to be used for Part A


Program Category Modifier Code Description
PART - A 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 - A Method II CAH 26 Professional component 
PART - A E/M 27 Multiple outpatient hospital Evaluation and Management (E/M) encounters on the same date. 
PART - A Anatomical 50 Bilateral procedure 
PART - A Radiological 52 Reduced service 
PART - A Surgical 58 Staged or related procedure or service by the same physician during the postoperative period on the same day. 
PART - A Anatomical 59 Distinct procedural service 
PART - A Method II CAH 62 Two surgeons
PART - A Outpatient hospital 73 Discontinued outpatient procedure prior to the administration of anesthesia.
PART - A Outpatient hospital 74 Discontinued outpatient procedure after administration of anesthesia.
PART - A Outpatient hospital 76 Repeat procedure or service by the same physician.
PART - A Outpatient hospital 77 Repeat procedure by another physician.
PART - A Outpatient hospital 78 Unplanned return to the operating/procedure room by the same physician following initial procedure for a related procedure during the postoperative period.
PART - A Outpatient hospital 79 Unrelated procedure or service by the same physician during the postoperative period.
PART - A Method II CAH 80 Assistant surgeon
PART - A Method II CAH 81 Minimum assistant surgeon
PART - A Method II CAH 82 When qualified resident surgeon not available.
PART - A Laboratory 91 Repeat clinical diagnostic laboratory test
PART - A Method II CAH AA Anesthesia services performed personally by anesthesiologist.
PART - A Method II CAH AE Registered dietitian
PART - A Method II CAH AH Clinical psychologist
PART - A Method II CAH AI Principal physician of record.
PART - A Method II CAH AK Non-participating physician
PART - A Method II CAH AQ Physician providing a service in an unlisted HPSA.
PART - A Method II CAH AS PA, NP or CNS services for assistant at surgery.
PART - A DMEPOS AU Item furnished in conjunction with a urological, ostomy or tracheostomy supply.
PART - A DMEPOS AV Item furnished in conjunction with a prosthetic device, prosthetic or orthotic.
PART - A DMEPOS AW Item furnished in conjunction with a surgical dressing.
PART - A Outpatient Hospital AY Item or service furnished to an End Stage Renal Disease (ESRD) patient that is not for the treatment of ESRD.
PART - A Blood BL Special acquisition of blood and blood products.
PART - A Outpatient hospital CA Procedure payable only in the inpatient setting when performed emergently on an outpatient who expires prior to admission.
PART - A Outpatient hospital CB Service ordered by a renal dialysis facility physician as part of the ESRD beneficiary’s dialysis benefit, is not part of the composite rate, and is separately reimbursable.
PART - A ESRD CD AMCC test has been ordered by an ESRD facility or MCP physician that is part of the composite rate and is not separately billable.
PART - A ESRD CE AMCC 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.
PART - A ESRD CF AMCC test has been ordered by an ESRD facility or MCP physician that is not part of the composite rate and is separately billable.
PART - A Catastrophe/disaster CR Catastrophe/disaster–related
PART - A Ambulance D Diagnostic or therapeutic site/freestanding facility (i.e., radiation therapy center) other than a physician’s office or hospital.
PART - A Ambulance E Residential/domiciliary/custodial facility (i.e., non-skilled facility).
PART - A Anatomical E1 Upper left, eyelid
PART - A Anatomical E2 Lower left, eyelid
PART - A Anatomical E3 Upper right, eyelid
PART - A Anatomical E4 Lower right, eyelid
PART - A Non-ESRD ESA EA Erythropoiesis Stimulating Agent (ESA) administered to treat anemia due to anti-cancer chemotherapy.
PART - A Non-ESRD ESA EB Erythropoiesis Stimulating Agent (ESA) administered to treat anemia due to anti-cancer radiotherapy.
PART - A Non-ESRD ESA EC Erythropoiesis Stimulating Agent (ESA) administered to treat anemia not due to anti-cancer chemotherapy or anti-cancer radiotherapy.
PART - A ESRD ED Hematocrit level has exceeded 39 percent (or hemoglobin level has exceeded 13.0 g/dL) for three or more consecutive billing cycles immediately prior to and including the current cycle.
PART - A ESRD EE Hematocrit level has exceeded 39 percent (or hemoglobin level has not exceeded 13.0 g/dL) for less than three consecutive billing cycles immediately prior to and including the current cycle.
PART - A ESRD EM Emergency reserve supply (for ESRD benefit only).
PART - A Outpatient hospital ET Emergency services
PART - A Non-covered charges EY No physician or other licensed health care provider order on file for this item or service.
PART - A Anatomical F1 Left hand, second digit
PART - A Anatomical F2 Left hand, third digit
PART - A Anatomical F3 Left hand, fourth digit
PART - A Anatomical F4 Left hand, fifth digit
PART - A Anatomical F5 Right hand, thumb
PART - A Anatomical F6 Right hand, second digit
PART - A Anatomical F7 Right hand, third digit
PART - A Anatomical F8 Right hand, fourth digit
PART - A Anatomical F9 Right hand, fifth digit
PART - A Anatomical FA Left hand, thumb
PART - A Credited device FB Item provided without cost or credit received for a replacement device (e.g., covered under warranty, replaced due to defect, free samples, etc.).
PART - A Credited device FC Partial credit received for replaced device.
PART - A Ambulance G Hospital-based dialysis facility (hospital or hospital-related).
PART - A ESRD G1 Most recent URR reading of less than 60 percent.
PART - A ESRD G2 Most recent URR reading of 60-64.9 percent.
PART - A ESRD G3 Most recent URR reading of 65-69.9 percent.
PART - A ESRD G4 Most recent URR reading of 70-74.9 percent.
PART - A ESRD G5 Most recent URR reading of 75 percent or greater.
PART - A ESRD G6 ESRD patient for whom less than seven dialysis sessions have been provided in a month.
PART - A Non-covered services GA Waiver of liability statement issued, as required by payer policy.
PART - A Method II CAH GC Service performed in part by a resident under the direction of a teaching physician.
PART - A Method II CAH GF Non-physician services in a Critical Access Hospital (CAH).
PART - A Outpatient hospital GG Performance and payment of a screening mammography and diagnostic mammography on same patient, same day.
PART - A Therapy GN Services delivered under an outpatient Speech-Language Pathology (SLP) plan of care.
PART - A Therapy GO Services delivered under an outpatient Occupational Therapy (OT) plan of care.
PART - A Therapy GP Services delivered under an outpatient Physical Therapy (PT) plan of care.
PART - A Method II CAH GQ Via asynchronous telecommunications system.
PART - A ESRD GS Dosage of EPO or DPO has been reduced and maintained in response to hematocrit or hemoglobin level.
PART - A Method II CAH GT Via interactive audio and video telecommunications system.
PART - A Non-covered services GX Notice of liability issued, voluntary under payer policy.
PART - A Non-covered services GY Item or service statutorily excluded or does not meet the definition of any Medicare benefit.
PART - A Non-covered services GZ Item or service expected to be denied as not reasonable or necessary.
PART - A Ambulance H Hospital (i.e., inpatient or outpatient).
PART - A Ambulance I Site of transfer (e.g., airport or helicopter pad) between modes of ambulance transport.
PART - A Ambulance J Non-hospital-based dialysis facility
PART - A ESRD JA Administered intravenously.
PART - A ESRD JB Administered subcutaneously.
PART - A ESRD JW Drug amount discarded/not administered to any patient.
PART - A Drugs and biologicals JW Drug amount discarded/not administered to any patient.
PART - A DMEPOS KM Replacement of facial prosthesis including new impression/moulage.
PART - A DMEPOS KN Replacement of facial prosthesis using previous master model.
PART - A Therapy KX Requirements specified in the medical policy have been met.
PART - A Anatomical LC Left circumflex coronary artery
PART - A Anatomical LD Left anterior descending coronary artery
PART - A Anatomical LT Left side
PART - A Ambulance N Skilled Nursing Facility (SNF)
PART - A Ambulance P Physician’s office (includes HMO and non-hospital facility).
PART - A Surgical PA Surgery wrong body part
PART - A Surgical PB Surgery wrong patient
PART - A Surgical PC Wrong surgery on patient
PART - A PET PI Positron 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.
PART - A PET PS Positron 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.
PART - A Diagnostic PT Colorectal cancer screening test; converted to diagnostic test or other procedure.
PART - A Clinical trials Q0 Investigational clinical service provided in a clinical research study that is in an approved clinical research study.
PART - A Clinical trials Q1 Routine clinical service provided in a clinical research study that is in an approved clinical research study.
PART - A 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).
PART - A Method II CAH QK Medical direction of two, three or four concurrent anesthesia procedures involving qualified individuals.
PART - A Ambulance QL Patient pronounced dead after ambulance called.
PART - A Ambulance QM Ambulance service provided under arrangement by a provider of services.
PART - A Ambulance QN Ambulance service furnished directly by a provider of services.
PART - A Method II CAH QY Medical direction of one CRNA by an anesthesiologist.
PART - A Method II CAH QZ CRNA service without medical direction by a physician.
PART - A Ambulance R Residence (patient’s home or any residence).
PART - A DMEPOS RA Replacement of a Durable Medical Equipment (DME), orthotic or prosthetic item.
PART - A DMEPOS RB Replacement of a part of a Durable Medical Equipment (DME), orthotic or prosthetic item furnished as part of a repair.
PART - A Anatomical RC Right coronary artery
PART - A Anatomical RT Right side
PART - A Ambulance S Scene of accident or acute event.
PART - A Method II CAH SB Nurse midwife
PART - A Anatomical T1 Left foot, second digit
PART - A Anatomical T2 Left foot, third digit
PART - A Anatomical T3 Left foot, fourth digit
PART - A Anatomical T4 Left foot, fifth digit
PART - A Anatomical T5 Right foot, great toe
PART - A Anatomical T6 Right foot, second digit
PART - A Anatomical T7 Right foot, third digit
PART - A Anatomical T8 Right foot, fourth digit
PART - A Anatomical T9 Right foot, fifth digit
PART - A Anatomical TA Left foot, great toe
PART - A Method II CAH TC Technical component 
PART - A Non-covered services TS Follow-up service
PART - A ESRD V5 Any Vascular Catheter (alone or with any other vascular access)
PART - A ESRD V6 Arteriovenous Graft (or other vascular access not including a vascular catheter)
PART - A ESRD V7 Arteriovenous Fistula Only (in use with two needles)
PART - A ESRD V8 Infection present
PART - A ESRD V9 No infection present
PART - A Ambulance X Intermediate stop at physician’s office en route to the hospital (destination code only).

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