Modifiers in medical billing are 2 digit codes added to CPT or HCPCS (Healthcare Professional Coding System) codes to provide extra information about the provided medical services. These Modifiers explain changes such as altered procedures, multiple services, or special circumstances without changing the main procedure codes. Modifiers are important in medical billing and RCM process, because they ensure accurate claim submission and correct reimbursement of the claim without denial. We created a list of Types of Modifiers in RCM used in Medical billing process with their description for help of user working in USA healthcare field.
Types of Modifiers in RCM with Description
| Modifier | Coding Instructions |
| 22 | Modifier 22 can be used on any procedure within the Anesthesia, Surgery, Radiology, Laboratory/Pathology, and Medicine series of codes. However, this modifier should not be used on E&M services. |
| 23 | Modifier 23 can only be submitted with anesthesia CPT codes 00100-01989, 01991, 01992, 01993, 01994, 01997, 01998, and 01999. Anesthesiologists, certified registered nurse anesthetists, or anesthesiologist assistants (AAs) should submit this modifier to indicate a procedure which is normally performed under local anesthesia or with a regional block required general anesthesia. |
| 24 | This modifier can be used to indicate that an E&M service or eye exam, which falls within the global period of a major or minor surgery, and which is performed by the surgeon, is unrelated to the surgery. |
| 25 | It may be necessary to indicate on the day a procedure or service identified by a CPT code was performed that the patient’s condition required a significant, separately identifiable E&M service above and beyond the other service provided or beyond the usual preoperative and postoperative care associated with the procedure that was performed. |
| 26 | If billing for the global component (professional & technical) of a procedure, modifiers 26 and TC should not be used. Modifier 26 can only be used by professional providers. It should not be used by a hospital. |
| 27 | Modifier 27 is used to identify multiple outpatient hospital E&M encounters on the same date. This modifier is not to be used by physician practices. It was created exclusively for hospital outpatient departments. For hospital outpatient reporting purposes, utilization of hospital resources related to separate and distinct E&M encounters performed in multiple outpatient hospital settings on the same date can be reported by adding modifier 27 to each appropriate level outpatient and/or emergency department E&M code(s). This modifier cannot be used for physician reporting of multiple E&M services performed by the same physician on the same date. This modifier is valid for the following CPT codes: 92004-92014, 99201-99239, 99281-99299, G0101, G0175, & G0380-G0384. |
| 32 | Modifier 32 (Mandated Services) is used when a third party (not the patient) requires a medical service. The request must come from an insurance company, government agency, school, or similar organization. Common situations where Modifier 32 applies: An insurance company asks for an independent medical evaluation (for example, a workers’ compensation case). A school requires a physical exam before a student can play sports. A child in state custody or foster care is sent for a required medical exam. An insurance company requires a second opinion before approving tests or treatment. Example: A cardiologist recommends mitral valve replacement. The insurance company only covers mitral valve repair and requires a second surgical opinion. The second doctor uses modifier 32 to show the visit was required by the insurer. Without modifier 32, the claim could be denied as a duplicate service. When Modifier 32 should NOT be used: If the patient or family asks for a second opinion. If one doctor consults another doctor on their own. For medical clearance before surgery or a procedure. Important Medicare note: Medicare usually does not accept modifier 32. Medicare typically will not pay for services requested by another provider. |
| 47 | This modifier should be appended only to the surgical procedure code when applicable. It is not appropriate to use this modifier on anesthesia procedure codes. The anesthesiologist would not use this modifier. Do not report modifier 47 when the physician reports moderate (conscious) sedation. |
| 50 | Bilateral services should be reported using modifier 50 when the same procedure is performed on both sides of the body, following the rules in the policy. Modifier 50 should not be used together with modifiers 53, 73, or 74 on the same claim line, because only a one-sided (unilateral) procedure can be reported as discontinued. When there is a single CPT code that already describes a bilateral procedure, that code must be reported by itself, rather than using a unilateral code with modifier 50. In addition, bilateral procedures should not be reported by using modifiers LT and RT on the same line; modifier 50 must be used instead to correctly indicate that the service was performed bilaterally. |
| 51 | Multiple Procedures |
| 52 | Under certain circumstances, a service or procedure is partially reduced or eliminated at the physician’s discretion. Do not use this modifier if the procedure is discontinued after administration of anesthesia (use modifier 53). |
| 53 | Under certain circumstances, the physician can elect to terminate a surgical or diagnostic procedure. Due to extenuating circumstances or those that threaten the well-being of the patient, it may be necessary to indicate that a surgical or diagnostic procedure was started but discontinued. This circumstance can be reported by adding modifier 53 to the code reported by the physician for the discontinued procedure. Modifier 53 should not be used on E&M codes. |
| 54 | When one physician performs a surgical procedure and another provides preoperative and/or postoperative management, surgical codes can be identified by adding the modifier 54. Physicians who perform the surgery and furnish all of the usual pre- and post-operative work bill for the global package by entering the appropriate CPT code for the surgical procedure only; therefore, modifiers 54 and 55 cannot be combined on a single detail line item. |
| 55 | When one physician performs the postoperative management and another physician performs the surgical procedure, the postoperative component can be identified by adding modifier 55 to the code. Physicians who perform the surgery and furnish all of the usual pre- and post-operative work bill for the global package by entering the appropriate CPT code for the surgical procedure only; therefore, modifiers 54 and 55 cannot be combined on a single detail line item. |
| 56 | When one physician performs the preoperative care and evaluation and another physician performs the surgical procedure, the preoperative component can be identified by adding modifier 56 to the code. Physicians who perform the surgery and furnish all of the usual pre- and post-operative work bill for the global package by entering the appropriate CPT code for the surgical procedure only. KMAP uses the Medicare Physician Fee Schedule Relative Value file to determine which procedures are appropriately billed with modifier 56. |
| 57 | Modifier 57 indicates an E&M service resulted in the initial decision to perform surgery either the day before a major surgery (90-day global period) or the day of a major surgery (90-day global period). Modifier 57 can only be used on E&M codes. |
| 58 | It may be necessary to indicate the performance of a procedure or service during the postoperative period was (a) planned or anticipated (staged); (b) more extensive than the original procedure; or (c) for therapy following a surgical procedure. Complications from surgery which do not require a return trip to the operating room are considered part of the global surgery package from the original surgery and are not payable separately. Modifier 58 is not appropriate in this situation. |
| 59 | Modifier 59 can be used for a different session, different procedure or surgery, different site or organ system, separate incision or excision, separate lesion, or separate injury. |
| 62 | When two surgeons work together as primary surgeons performing distinct part(s) of a procedure, each surgeon must report his or her distinct operative work by adding modifier 62 to the procedure code and any associated add-on codes for that procedure as long as both surgeons continue to work together as primary surgeons. |
| 63 | Procedures performed on neonates and infants up to a present body weight of four kg may involve significantly increased complexity and physician work commonly associated with these patients. This circumstance can be reported by adding modifier 63 to the procedure code. Modifier 63 can only be appended to procedures/services listed in the 20000-69990 code series of the CPT codebook. Modifier 63 cannot be appended to any codes listed in the E&M, Anesthesia, Radiology, Pathology/Laboratory, or Medicine series of codes in the CPT codebook. |
| 66 | Highly complex procedures (requiring the concomitant services of several physicians, often of different specialties, plus other highly skilled, specially trained personnel, various types of complex equipment) are carried out under the “surgical team” concept. |
| 73 | Submit modifier 73 for ASC (Ambulatory surgery centers) facility charges when the surgical procedure is discontinued before anesthesia is administered. This modifier cannot be submitted by the operating surgeon. Only ASCs can submit this modifier. Surgeons can refer to modifier 53. Modifier 73 is used by the facility to indicate a surgical or diagnostic procedure requiring anesthesia was terminated due to extenuating circumstances or to circumstances that threatened the well-being of the patient after the patient had been prepared for the procedure (including procedural premedication when provided) and taken to the room where the procedure was to be performed but prior to administration of anesthesia. |
| 74 | Submit modifier 74 for ASC facility charges when the surgical procedure is discontinued after anesthesia is administered. This modifier cannot be submitted by the operating surgeon. Only ASCs can submit this modifier. Surgeons can refer to modifier 53. Due to extenuating circumstances or those that threaten the well-being of the patient, the physician may terminate a surgical or diagnostic procedure after the administration of anesthesia (local, regional block, or general) or after the procedure was started (incision made, intubation started, scope inserted, etc.). Under these circumstances, the procedure started but terminated can be reported by its usual procedure number and the addition of modifier 74. For a physician reporting a discontinued procedure, see modifier 53. This modifier was created so the costs incurred by the hospital to initiate the procedure (preparation of the patient, procedure room, recovery room) can be recognized for payment even though the procedure was discontinued prior to completion. |
| 76 | When a diagnostic procedure is performed during separate patient encounters (such as, different times of the day), the second code can be reported with modifier 76. Modifier 76 is used when the procedure is repeated by the same physician subsequent to the original service. The repeat service must be identical to the initial service provided. This modifier is separate and distinct from modifiers 58, 78, and 79. Refer to details for these modifiers. Repeat procedures for Clinical Diagnostic Laboratory codes can be billed with modifier 91 not 76. The Medicare Clinical Diagnostic Laboratory Fee Schedule from the CMS website is used to determine which procedures are considered to be Clinical Diagnostic Lab procedures. |
| 77 | Modifier 77 is used when a procedure is repeated by a different physician subsequent to the original service; the repeat service must be identical to the initial service provided.Use modifier 77 to report the same procedure performed more than once on the same date of service but at different encounters. Repeat procedures for clinical diagnostic laboratory codes can be billed with modifier 91 instead of modifier 77. |
| 78 | Modifier 78 used when an unplanned return to the operating or procedure room by the same physician or qualified healthcare professional for a related procedure during the postoperative (global) period of an initial surgery, typically for managing complications like infection or hemorrhage. |
| 79 | Unrelated procedure or service by the same physician during the postoperative period. |
| 80 | Surgical assistant services can be identified by adding modifier 80 to the usual procedure code. Use modifier 80 when the assistant at surgery service is provided by a medical doctor (MD). Modifier 80 can only be used by professional providers. It should not be used by a hospital.Physician assistants (PAs), nurse practitioners (NPs), and clinical nurse specialists (CNSs) cannot submit this modifier. |
| 81 | Although a primary operating physician may plan to perform a surgical procedure alone, during the operation circumstances can arise requiring the services of an assistant surgeon for a relatively short time. In this instance, the second surgeon provides minimal assistance, for which he or she reports the surgical procedure code with modifier 81. Modifier 81 can only be used by professional providers. It should not be used by a hospital. |
| 82 | When a qualified resident surgeon is not available, and another surgeon assists in the operation. In these instances, the services of the nonresident assistant surgeon are reported with modifier 82. Use modifier 82 when the assistant at surgery service is provided by an MD when there is not a qualified resident available. Documentation must include information relating to the unavailability of a qualified resident in this situation. Modifier 82 can only be used by professional providers. It should not be used by a hospital. This modifier can only be submitted with surgery codes. |
| 90 | The American Medical Association (AMA) developed modifier 90 for use by a physician or clinic when laboratory tests for a patient are performed by an outside or reference laboratory. |
| 91 | During the course of patient treatment, it may be necessary to repeat the same laboratory test on the same day to obtain subsequent (multiple) test results. Under these circumstances, the laboratory test performed can be identified by the addition of modifier 91. Modifier 91 is used to identify a lab test performed more than once on the same day for the same patient when multiple results are necessary for proper treatment. |
| 92 | Alternative Laboratory Platform Testing,” used when tests are performed via a transportable kit or disposable, single-use instrument (e.g., rapid HIV tests). It is primarily applied to CPT codes 86701–86703 for HIV antibody testing to indicate immediate, point-of-care results rather than traditional lab testing. |
| 93 | Modifier 93 is used for synchronous, audio-only, real-time interactive communication between a provider and a patient, effective from January 1, 2022. It applies when technical limitations, patient preference, or lack of video capability prevents video-based telehealth. |
| 95 | Modifier 95 indicates a synchronous, real-time, audio-video telemedicine service between a provider and a patient, typically allowing for reimbursement equivalent to in-person care. |
| 96 | CPT Modifier 96 describes Habilitative Services, used for therapies that help patients develop or learn skills for daily living (activities of daily living – ADLs) that they haven’t yet acquired or are at risk of losing, often for conditions like developmental delays. |
| 97 | CPT Modifier 97 identifies Rehabilitative Services, used when a provider helps a patient restore or improve skills/functions lost due to illness, injury, or disability, distinct from Modifier 96 (Habilitative), which teaches new skills. |
| 99 | CPT Modifier 99, “Multiple Modifiers,” acts as a placeholder when more than two modifiers are needed for a single procedure code, signaling payers to look for additional details. |
| A1 A2 A3 A4 A5 A6 A7 A8 A9 | Modifiers A1 through A9 indicate a particular item is being used as a primary or secondary dressing on a surgical or debrided wound and also indicate the number of wounds on which that dressing is being used. The modifier number must correspond to the number of wounds on which the dressing is being used, not the total number of wounds treated. Modifiers A1 through A9 are used for informational purposes and are not required. |
| AA | Anesthesia modifiers are required for procedure codes 00100-01989, 01991-01995, and 01997-01999. This anesthesia modifier must be reported with anesthesia services in the first modifier field to indicate who performed the anesthesia service. Anesthesia services billed without one of these modifiers will be denied. |
| AD | Anesthesia modifiers are required for procedure codes 00100-01989, 01991-01995, and 01997-01999. This anesthesia modifier must be reported with anesthesia services in the first modifier field to indicate who performed the anesthesia service. Anesthesia services billed without one of these modifiers will be denied. Anesthesia modifiers submitted on services other than anesthesia will cause the service to be denied. Services billed to KMAP with this modifier will be denied as noncovered. |
| AE | This modifier can be submitted with claims for Medical Nutrition Therapy (MNT) and Diabetes Self-Management Training (DSMT). |
| AF AG | These modifiers can be submitted with all HCPCS and CPT codes. |
| AH | Submit this modifier with diagnostic psychological tests and therapeutic psychotherapy performed by a clinical psychologist. This modifier can be submitted with the following procedure codes. CPT codes: 90802, 90803, 90806, 90808, 90826, 90828, 90830-90856, 90863-90885, 90899, and 96105-96120, 96130, 96131. HCPCS codes: G0071, G0077, G0079, G0081, G0083, G0085, G0087, and G0089. |
| AI | The AI modifier in medical billing signifies the “Principal Physician of Record,” used by the admitting or attending doctor for initial inpatient hospital or nursing facility care (CPT codes 99221-99223, 99304-99306) to identify them as the primary caregiver, preventing denials from other specialists seeing the patient the same day. |
| AJ | The AJ modifier in medical billing identifies the provider as a Licensed Clinical Social Worker (LCSW), used to provide more specific information about the professional rendering a service, especially in behavioral health, though its requirement varies by insurance payer, with some like Medicare potentially needing it for proper reimbursement of LCSW services.Submit this modifier with diagnostic psychological tests and therapeutic psychotherapy performed by a clinical social worker. This modifier can be submitted with the following procedure codes: CPT codes: 90802, 90806, 90808, 90826, 90828, 90841-90856, and 90875-90876, 90885 HCPCS codes: G0071, G0077, G0079, G0081, G0083, G0085, G0087, G0089, G90806, and G90808. |
| AK AM | Modifier AK: Nonparticipating Physician. Modifier AM: Physician, Team Member Service |
| AP | Modifier AP (HCPCS) indicates that a determination of refractive state was not performed during a diagnostic ophthalmological exam. This modifier can be submitted with CPT codes 92002, 92004, 92012, and 92014. |
| AQ AR | The AQ modifier in medical billing signifies that a service was provided in a Health Professional Shortage Area (HPSA), allowing for enhanced reimbursement for physicians and certain providers, used specifically for geographic HPSAs and certain zip codes not fully captured by automated lists after January 1, 2006, replacing older modifiers like QB/QU for these designated areas. |
| AS | Use modifier AS for assistant at surgery services provided by a PA, NP, and CNS. Modifier AS can only be used by the professional providers identified. It should not be used by a hospital. Modifier AS is a processing modifier and the rate is 25% of the base code. |
| AT | The “AT” modifier in medical billing stands for Active Treatment, used primarily by chiropractors for Medicare claims to show services are for correcting acute/chronic subluxations, not just maintenance, requiring documentation of potential functional improvement. |
| AV | HCPCS modifier AV signifies an “item furnished in conjunction with a prosthetic device, prosthetic or orthotic”. It is primarily used in Medicare DMEPOS claims to specify that supplies, particularly adhesives (A4450, A4452) or skin barriers (A5120), are used with facial prostheses. Proper use is mandatory to prevent claim denials for non-covered items. |
| AX | Modifier AX is a HCPCS Level II modifier, defined as “item furnished in conjunction with dialysis services”. It is used by End-Stage Renal Disease (ESRD) facilities on Type of Bill (TOB) 072X to indicate that a specific drug, biological product, or equipment is provided during, or to support, a renal dialysis treatment. |
| AY | This modifier was developed for Medicare purposes. Medicare uses this modifier as an end stage renal disease (ESRD) consolidated billing requirement for services included in the ESRD facility bundled payment. At this time, there are no special coding instructions applicable to Medicaid claims billing for this modifier. |
| AZ | HCPCS Modifier AZ is used to identify services provided by a physician in a designated dental health professional shortage area (DHPSA) specifically for the purpose of an electronic health record (EHR) incentive payment. |
| BA | Modifier BA must be used for items being supplied in conjunction with total parenteral nutrition (TPN). For parenteral supplies, add modifier BA to the base code (XXXXX-BA) and place in Field 24D when billing for items and supplies in conjunction with TPN. For further billing/coding instructions, refer to the Home Health Agency Fee-for-Service Provider Manual and DME/Medical Supply Dealer Fee-for-Service Provider Manual. |
| BL | HCPCS modifier BL indicates the special acquisition of blood and blood products. It is used in medical billing, specifically under the Outpatient Prospective Payment System (OPPS), when an entity purchases blood/blood products from a community blood bank or when a provider-run blood bank charges for collected blood. |
| BO | Modifier BO is a HCPCS Level II informational modifier, defined as “Orally administered nutrition, not by feeding tube”. It is used to specify that enteral nutrition products (such as B4153, B4154, B4161) were consumed orally, distinguishing this from, and often disqualifying coverage for, tube-delivered, formula-based, or Durable Medical Equipment (DME) services. |
| BP | Modifier BP is a HCPCS Level II modifier used in DMEPOS billing to indicate that a beneficiary has been informed of both purchase and rental options for an item and has specifically elected to purchase it. It is frequently used for capped rental items, such as certain power wheelchairs (K0835-K0864) and enteral pumps, to confirm the chosen payment method. |
| BR BU | Modifiers BR and BU are HCPCS Level II codes used in DMEPOS billing to indicate that a beneficiary was informed of purchase/rental options for items like Parenteral/Enteral (PEN) pumps or complex rehabilitative power wheelchairs. |
| CA | Modifier CA indicates an inpatient-only procedure (Status Indicator “C” in OPPS Addendum B) was performed on an outpatient who died before admission, or was transferred/stabilized in an emergency room/operating room. |
| CB | This modifier was developed for Medicare payment purposes. Medicare Usage Service ordered by a renal dialysis facility (RDF) physician as part of the ESRD member’s dialysis benefit is not part of the composite rate and is separately reimbursable. Guidelines/Instructions Submit this modifier only when it has been determined that ALL of the following apply: · The patient is entitled to Medicare based on ESRD. · The test is related to the dialysis treatment for ESRD. · The test was ordered by a doctor providing care to patients in the dialysis facility. · The test is not included in the dialysis facility’s composite rate payment. |
| CC | In medical coding, the CC modifier signifies a procedure code change, used when the submitted code was incorrect or needs alteration for administrative reasons, but it’s typically for internal use by contractors, not for providers to submit. |
| CD CE CF | These modifiers were developed for Medicare purposes. Medicare uses these modifiers as pricing modifiers to identify the different payment situations for ESRD Automated Multi-Channel Chemistry (AMCC) services. The ESRD clinical diagnostic laboratory tests identified with modifiers CD, CE, or CF cannot be billed as organ or disease panels. |
| CG | Modifier CG (“policy criteria applied”) is primarily used by Rural Health Clinics (RHCs) to identify the main, billable visit line for Medicare, enabling payment at the All-Inclusive Rate (AIR). |
| CH CI CJ CK CL CM CN | Modifiers CH through CN are HCPCS level II functional limitation severity/complexity modifiers used in Medicare billing to report the percentage of impairment for therapy services (physical, occupational, speech). |
| CR | HCPCS modifier CR is used by Medicare to track and facilitate claims processing for disaster victims. This modifier can only be submitted with services that are related to a disaster or catastrophe, such as Hurricane Katrina in 2005. |
| CS | Cost-sharing waived for Medicare Part B COVID-19 testing-related services. |
| CT | This modifier should be submitted when a computed tomography (CT) service is completed using equipment that does not meet the National Electric Manufacturers Association XR-29-2013 standard. This modifier is used for pricing when submitted with procedure codes in the following ranges: 70450-70498, 71250-71275, 72191-72194, 73200-73206, 73700-73706, 74150-74178, 74261-74263, and 75571-75574. The technical component of these procedures will be reduced by 15%. Effective since January 1, 2016, this modifier indicates to insurers that the equipment lacks specific dose-tracking, automatic exposure control, and reporting protocols. |
| DA | HCPCS Modifier DA indicates an oral health assessment by a licensed health professional other than a dentist. This informational modifier is used to identify that a, usually preventive, assessment was performed by a non-dentist provider, such as a nurse practitioner or physician assistant, often in a primary care setting. |
| E1 E2 E3 E4 | These modifiers are anatomic-specific modifiers. These modifiers are for surgical and diagnostic services. These modifiers are not for E&M services. When eyelid procedures are coded, instead of modifier RT or LT, the procedure code must be appended with modifiers E1 through E4 to indicate upper and lower eyelid. |
| EA EB EC EA EB EC | CMS uses these modifiers to gather information to determine the prevalence and severity of anemia associated with cancer therapy, the clinical and hematologic responses to the institution of antianemia therapy, and the outcomes associated with various doses of antianemia therapy. If these modifiers are used, they are only valid when submitted with the following codes on non-ESRD claims for ESAs: J0881, J0882, J0885, J0886, and Q4081. |
| ED EE | CMS uses these modifiers for national claims monitoring for ESAs administered to ESRD patients receiving dialysis in a renal dialysis facility. Submit these modifiers when the following criteria are met: – The ESA is administered to an ESRD patient receiving dialysis in a renal dialysis facility. – The patient’s hematocrit level has exceeded 39.0% (or hemoglobin level has exceeded 13.0g/dl) for three or more consecutive billing cycles immediately prior to and including the current billing cycle. |
| EJ | This modifier is purely informational and can be submitted with many HCPCS J-codes for injections. |
| EM | At this time, there are no special coding instructions applicable to Medicaid claims billing for this modifier. |
| EP | Modifier EP is to be used for EPSDT services where modifier 32 was previously used. Modifier 32 is no longer valid for EPSDT services. CMS no longer recognizes CPT codes 99202, 99211, and 99212 as qualifying EPSDT screens. These codes are no longer valid for EPSDT screens and should not be billed with modifier EP. |
| ET | This modifier is for informational use only and can be submitted with codes 99281-99285, 99291, and 99292. Physicians and mid-level practitioners should use codes 99281-99285 and 99291-99292 for emergency room visits without modifier ET. For further billing and coding instructions, refer to the Hospital Fee-for-Service Provider Manual or Professional Fee-for-Service Provider Manual. |
| EX | This modifier is informational. It can be used to identify an expatriate member. |
| EY | CMS instituted modifier EY to allow DME suppliers to submit claims to Medicare for items without a prescription. Since there is no physician or provider information to report on claims for these items, modifier EY is used in conjunction with a surrogate unique physician identification number (UPIN) in the ordering/referring provider name fields of the claim. This protocol was adopted so that suppliers could obtain a Medicare denial which could be sent to a secondary insurer for COB purposes. Services and supplies billed to KMAP with modifier EY will be denied. KMAP will not reimburse for services or supplies not ordered by a licensed health care provider. |
| FA | This modifier is an anatomic-specific modifier and is appropriate for surgical and diagnostic services. This modifier is not appropriate for E&M services. |
| FB | This modifier is intended for use with procedures or devices submitted by ASCs. ASCs must append modifier FB to the HCPCS device procedure code when the device is furnished without cost or with full credit and only when billed with the associated implantation procedure code found in List A below. A single code should not be submitted with both modifiers FB and FC. For further billing instructions, refer to CMS CR7275. This modifier can be reported with the following HCPCS codes for devices: C1721, C1722, C1764, C1767, C1771, C1772, C1776, C1777, C1778, C1779, C1820, C1833, C1881, C1882, C1889, C1891, C1895, C1896, C1897, C1898, C1899, C2626, C2631, and L8614. List A: 33206, 33207, 33208, 33210, 33211, 33212, 33213, 33214, 33216, 33217, 33285, 33286, 36566, 53440, 53444, 53445, 53447, 54400, 54401, 54405, 54410, 62362, 63650, 63655, 63685, 64553, 64555, 64561, 64568, 64584, 64590, and 69930. |
| FC | This modifier is intended for use with procedures or devices submitted by ASCs. ASCs must append modifier FC to the HCPCS device procedure code for the surgery when a device is furnished with a partial credit for a replacement device. A single procedure code should not be submitted with both modifiers FB and FC. For further billing instructions, refer to CMS CR7275. This modifier can be reported with the following HCPCS codes for devices: C1721, C1722, C1764, C1767, C1771, C1772, C1776, C1777, C1778, C1779, C1785, C1786, C1813, C1815, C1820, C1833, C1881, C1882, C1889, C1891, C1895, C1896, C1897, C1898, C1899, C1900, C2619, C2620, C2621, C2622, C2626, C2631, and L8614. List A: 33206, 33207, 33208, 33210, 33211, 33212, 33213, 33214, 33216, 33217, 33240, 33249, 33224, 33225, 33285, 33286, 36566, 53440, 53444, 53445, 53447, 54400, 54401, 54405, 54410, 54416, 61885, 61886, 62361, 62362, 63650, 63655, 63685, 64553, 64555, 64561, 64568, 64575, 64577, 64580, 64581, 64584, 64590, and 69930. |
| FP | Modifier FP is a HCPCS level II modifier defined as “Service provided as part of family planning program”. It is used in medical billing to designate services related to family planning, such as contraceptive management, ensuring proper reimbursement under specific insurance plans, particularly Medicaid. |
| FQ FR FS FT | Modifiers FQ, FR, FS, and FT are HCPCS Level II codes introduced to support 2022 and later telehealth and billing requirements, primarily for Medicare. |
| FX | Modifier FX was created to identify claims where an X-ray service was furnished using film. Payment for the technical component of procedures submitted with modifier FX are reduced by 20%. |
| FY | Modifier FY was created to identify claims where an X-ray service was furnished using computed radiography technology/cassette-based imaging. Payment for the technical component of procedures submitted with modifier FY are reduced by 7%. |
| G1 G2 G3 G4 G5 G6 | Modifiers G1 through G6 are used for reporting the urea reduction ratio (URR) for determining the adequacy of hemodialysis. KMAP will deny the service if billed with any of these modifiers for codes other than G0491, G0492, and 90999. |
| G7 | This modifier can only be submitted with the following CPT codes: 00940, 1965, 01966, 59840, 59841, 59850, 59851, 59852, 59855, 59856, 59857, 59866, S0190, S0191, S0199, and S2260. |
| G8 | Modifier G8 should only be used with the following anesthesia codes: 00100, 00160, 00300, 00400, 00532, and 00920. This modifier can be reported in the second position under appropriate circumstances in addition to anesthesia modifiers AA, AD, QK, QX, QY, and QZ (billed in the first position). |
| G9 | This anesthesia modifier can be submitted on procedure codes 00100-01989, 01991-01995, and 01997-01999. This modifier can be reported in the second position under appropriate circumstances in addition to anesthesia modifiers AA, AD, QK, QX, QY, and QZ (billed in the first position). Anesthesia modifiers submitted on services other than anesthesia will cause the service to be denied. |
| GA GB | At this time, there are no special coding instructions applicable to Medicaid claims billing for this modifier. |
| GC | Modifier GC must be used by the physician for teaching physician services. A teaching physician service billed using this modifier is certifying that he or she has been present during the key portion of the service and was immediately available during the other parts of the service. |
| GD | At this time, there are no special coding instructions applicable to Medicaid claims billing for this modifier. |
| GE | Submit this modifier with services performed by a resident in a teaching facility without the presence of a teaching physician. This modifier is informational and can only be submitted with procedure codes included in the primary care exception. HCPCS code: G0402 CPT codes: 99202, 99203, 99211, 99212, 99213, 93005, and 93041. |
| GF | For services rendered in a CAH by a NP, CNS, CRN, or PA, use this modifier. |
| GG | Modifier GG is used when a diagnostic and a screening mammogram are performed on the same day for the same patient. Modifier GG is added to the diagnostic mammography code only. Both the diagnostic and screening codes must be billed on the same claim form. Submit modifier GG with the diagnostic mammography code. CMS uses this modifier for tracking and data collection purposes. This modifier can be submitted with the following: CPT codes: 76706, 77051, 77055, 77056, 77065, and 77066. KMAP will deny the service if this modifier is billed with any code other than those listed. |
| GH | When a screening mammogram indicates a potential problem, the interpreting radiologist can order additional films during the same visit on the same day without an additional order from the treating physician. The radiologist must report to the treating physician the condition of the patient. These additional films, with the report to the treating physician, convert a screening mammogram to a diagnostic mammogram. The procedure code is reported with modifier GH to indicate the radiologist converted the screening mammogram to a diagnostic mammogram. This modifier can be submitted with CPT codes: 76706, 77055, 77056, 77065, and 77066. KMAP will deny the service if this modifier is billed with any code other than those listed. |
| GJ | This modifier is used specific to Medicare. Medicare rules: Physicians who have opted out of Medicare (also called private contracting) are not permitted to submit services to Medicare; however, the exception to this rule is when services are provided on an emergent or urgent basis. Opt-out physicians and practitioners must submit these services to Medicare with modifier GJ. To opt out of Medicare, physicians and practitioners who are permitted to opt out must follow certain procedures and guidelines. |
| GK GL | Modifiers GK and GL are HCPCS Level II modifiers used in DMEPOS (Durable Medical Equipment, Prosthetics, Orthotics, and Supplies) billing to manage “upgraded” items that exceed Medicare’s basic coverage, allowing for automated downcoding to the least costly alternative (LCA). GK indicates an upgrade with an ABN (Advance Beneficiary Notice), while GL indicates an upgrade provided at no extra charge. |
| GN | Submit modifier GN to indicate the services were delivered under an outpatient speech language pathology plan of care. |
| GO | Submit modifier GO to indicate services delivered under an outpatient occupational plan of care. |
| GP | Submit modifier GP with services delivered under an outpatient physical therapy plan of care. |
| GQ | Modifier GQ can only be submitted with the following codes: 90847, 90951, 90952, 90954, 90955, 90957, 90958, 90960, 90961, 96116, 97802, 97803, 99202, 99203, 99204, 99205, 99206, 99207, 99208, 99209, 99210, 99211, 99212, 99213, 99214, 99215, 99246, 99247, 99248, 99249, 99250, 99261, G0270, G0406, G0407, G0408, G0508, G0509, H0001, H0004, H0005, H0006, H0007, H0015, H0038, T1030, T1031, and Q3014. |
| GR | The HCPCS Level II modifier “-GR” indicates that a service was performed in whole or in part by a physician resident at a VA Medical Center or Clinic under proper supervision. |
| GS | Modifier GS indicates that the dosage of an Erythropoiesis-Stimulating Agent (ESA), such as Epoetin alfa or Darbepoetin alfa, has been reduced and maintained based on a patient’s hematocrit or hemoglobin levels. |
| GV | Modifier GV HCPCS Level II codes used for Medicare beneficiaries in hospice care to manage billing for services rendered outside the hospice agency. GV indicates services related to the terminal illness by an attending physician not employed by the hospice, while GW indicates services unrelated to the terminal condition. |
| GW | Modifier GW is a Medicare billing code indicating that services rendered to a hospice patient are unrelated to their terminal condition. It is essential for ensuring payment for non-hospice care (e.g., a broken bone while on hospice for cancer) and must be appended to HCPCS/CPT codes. |
| GX | The GX modifier in medical billing signifies that a provider issued a voluntary Advance Beneficiary Notice of Noncoverage (ABN) for a service that Medicare considers non-covered or statutorily excluded, informing the patient they’ll be responsible for payment; Medicare automatically denies claims with the GX modifier, allowing the provider to bill the patient directly after telling them the service isn’t covered, unlike the GA modifier which is for expected denials due to medical necessity. |
| GY | The GY modifier indicates that a service or item is statutorily excluded from Medicare coverage or does not meet the definition of any Medicare benefit. It is used to trigger an automatic, proper denial, allowing providers to bill patients directly or seek secondary insurance payment. |
| GZ | The GZ modifier indicates that a service is expected to be denied by Medicare as not reasonable and necessary, and no Advance Beneficiary Notice (ABN) was obtained. It signals that the provider, rather than the beneficiary, assumes financial liability for the denied claim. This modifier is used for informational purposes to trigger auto-denial, and it should not be used in conjunction with the GA modifier. |
List of Modifiers in Medical Billing help to prevent claim denial by clearly explaining how, why, or where a service was performed. Proper use of modifiers supports compliance with payer guidelines, improves billing transparency, and reflects the true complexity of medical services in United States. Overall, modifiers play a key role in fair payment and clear provider-payer communication.