| Mod Code | Mod Type | Mod Type Desc | Description |
| 1P | U | Not Used | Performance measure exclusion modifier due to medical reasons |
| 21 | I | Inactive | Prolonged evaluation and management services |
| 22 | P | Pricing | Increased procedural services |
| 23 | U | Not Used | Unusual anesthesia |
| 24 | N | NCCI | Unrelated evaluation and management service by the same physician or other qualified health care professional during a postoperative period |
| 25 | N | NCCI | Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service |
| 26 | R | Routing | Professional component |
| 27 | N | NCCI | Multiple outpatient hospital E/M encounters on the same date |
| 2P | U | Not Used | Performance measure exclusion modifier due to patient reasons |
| 32 | P | Pricing | Mandated services |
| 33 | U | Not Used | Preventive services |
| 3P | U | Not Used | Performance measure exclusion modifier due to system resources |
| 47 | U | Not Used | Anesthesia by surgeon |
| 50 | P | Pricing | Bilateral procedure |
| 51 | U | Not Used | Multiple procedures |
| 52 | Q | Pricing/Reporting | Reduced services |
| 53 | U | Not Used | Discontinued procedure |
| 54 | R | Routing | Surgical care only |
| 55 | R | Routing | Postoperative managemnt only |
| 56 | P | Pricing | Preoperative management only |
| 57 | N | NCCI | Decision for surgery |
| 58 | N | NCCI | Staged or related procedure or service by the same physician during the postoperative period |
| 59 | C | NCCI/Pricing | Distinct procedural service |
| 62 | P | Pricing | Two surgeons |
| 63 | U | Not Used | Procedure performed on infants less than 4kg |
| 66 | P | Pricing | Surgical team |
| 73 | U | Not Used | Discontinued outpatient hospital/ambulatory aurgery center (ASC) procedure prior to the administration of anesthesia |
| 74 | U | Not Used | Discontinued outpatient hospital/ambulatory aurgery center (ASC) procedure after administration of anesthesia |
| 76 | U | Not Used | Repeat procedure or service by same physician or other qualified health care professional |
| 77 | U | Not Used | Repeat procedure by another physician or other qualified health care professional |
| 78 | N | NCCI | Unplanned return to the operating/procedure room by the same physician or other qualified healthcare professional following initial procedure for a related procedure during the postoperative period |
| 79 | N | NCCI | Unrelated procedure or service by the same physician or other qualfied healthcare professional during the postoperative period |
| 80 | R | Routing | Assistant surgeon |
| 81 | U | Not Used | Minimum assistant surgeon |
| 82 | U | Not Used | Assistant surgeon (when qualified resident surgeon not available) |
| 8P | U | Not Used | Performance measure reporting modifier, action not performed, reason not otherwise specified |
| 90 | U | Not Used | Reference (outside) laboratory |
| 91 | N | NCCI | Repeat clinical diagnostic laboratory test |
| 92 | U | Not Used | Alternative Laboratory Platform Testing |
| 93 | U | Not Used | Synchronous Telemedicine Service Rendered Via Telephone or Other Real-Time Interactive Audio-Only Telecommunications System |
| 95 | U | Not Used | Synchronous Telemedicine Service Rendered Via a Real-Time Interactive Audio and Video Telecommunications System |
| 96 | P | Pricing | Habilitative services |
| 97 | U | Not Used | Rehabilitative Serivces |
| 99 | U | Not Used | Multiple modifiers |
| A1 | U | Not Used | Dressing for one wound |
| A2 | U | Not Used | Dressing for two wounds |
| A3 | U | Not Used | Dressing for three wounds |
| A4 | U | Not Used | Dressing for four wounds |
| A5 | U | Not Used | Dressing for five wounds |
| A6 | U | Not Used | Dressing for six wounds |
| A7 | U | Not Used | Dressing for seven wounds |
| A8 | U | Not Used | Dressing for eight wounds |
| A9 | U | Not Used | Dressing for 9 or more wounds |
| AA | R | Routing | Anesthesia services performed personally by anesthesiologist |
| AB | U | Not Used | Audiology service furnished personally by an audiologist without a physician-npp order for non-acute hearing assessment unrelated to disequilibrium, or hearing aids, or examinations for the purpose of prescribing, fitting, or changing hearing aids; service may be performed once every 12 months, per beneficiary |
| AD | U | Not Used | Medical supervision by a physician: more than four concurrent anesthesia procedures |
| AE | P | Pricing | Registered dietician |
| AF | P | Pricing | Specialty physician |
| AG | U | Not Used | Primary physician |
| AH | P | Pricing | Clinical psychologist |
| AI | U | Not Used | Principal physician of record |
| AJ | P | Pricing | Clinical social worker |
| AK | U | Not Used | Non participating physician |
| AM | P | Pricing | Physician, team member services (CSTAR) |
| AO | U | Not Used | Alternate payment method declined by provider of service |
| AP | U | Not Used | Determination of refractive state was not performed in the course of diagnostic opthalmological examination |
| AQ | U | Not Used | Physician providing a service in an unlisted health professional shortage area (HPSA) |
| AR | T | Reporting | Physician provider services in a physician scarcity area/physician assistant services |
| AS | U | Not Used | Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery |
| AT | U | Not Used | Acute treatment (this modifier should be used when reporting service 98940, 98941, 98942) |
| AU | P | Pricing | Item furnished in conjunction with a urological, ostomy, or tracheostomy supply |
| AV | U | Not Used | Item furnished in conjunction with a prosthetic device, prosthetic or orthotic |
| AW | U | Not Used | Item furnished in conjunction with a surgical dressing |
| AX | U | Not Used | Item furnished in conjunction with a dialysis services |
| AY | U | Not Used | Item or service to an ESRD patient that is not for the treatment of ESRD |
| AZ | U | Not Used | Physician providing a service in a dental health professional shortage area for the purpose of an electronic health record incentive payment |
| BA | P | Pricing | Item furnished in conjuction with parenteral enteral nutrition (PEN) services |
| BL | U | Not Used | Special acquisition blood and blood products |
| BO | P | Pricing | Orally administered nutrition, not by feeding tube |
| BP | U | Not Used | The beneficiary has been informed of the purchase and rental options and has elected to purchase the item |
| BR | U | Not Used | The beneficiary has been informed of the purchase and rental options and has elected to rent the item |
| BU | U | Not Used | The beneficiary has been informed of the purchase and rental options and after 30 days has not informed the supplier of his/her decision |
| CA | U | Not Used | Procedure payable only in the inpatient setting when performed emergently on an outpatient who expires prior to admission |
| CB | U | Not Used | Service 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 |
| CC | U | Not Used | Procedure code change |
| CD | U | Not Used | AMCC test has been ordered by an ESRD facility or MCP physician that is part of the composite rate and is not separately billable |
| CE | U | Not Used | 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 |
| CF | U | Not Used | AMCC test has been ordered by an ESRD facility or MCP physician that is not part of the composite rate and is separately billable |
| CG | P | Pricing | Money follows the person demonstration grant |
| CH | U | Not Used | 0 percent impaired, limited or restricted |
| CI | U | Not Used | At least 1 percent but less than 20 percent impaired, limited or restricted |
| CJ | U | Not Used | At least 20 percent but less than 40 percent impaired, limited or restricted |
| CK | U | Not Used | At least 40 percent but less than 60 percent impaired, limited or restricted |
| CL | U | Not Used | At least 60 percent but less than 80 percent impaired, limited or restricted |
| CM | U | Not Used | At least 80 percent but less than 100 percent impaired, limited or restricted |
| CN | U | Not Used | 100 percent impaired, limited or restricted |
| CO | U | Not Used | Outpatient occupational therapy services furnished in whole or in part by an occupational therapy assistant |
| CP | U | Not Used | Adjunctive service related to a procedure assigned to a comprehensive ambulatory payment classification (C-APC) procedure, but reported on a different claim |
| CQ | U | Not Used | Outpatient physical therapy services furnished in whole or in part by a physical therapist assistant |
| CR | Q | Pricing/Reporting | Catastrophe/disaster related |
| CS | U | Not Used | Cost-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. |
| CT | U | Not Used | Computed tomography services furnished using equipment that does not meet each of the attributes of the national electrical manufacturers association (NEMA) xr-29-2013 standard |
| DA | U | Not Used | Oral health assessment by a licensed health professional other than a dentist |
| DE | I | Inactive | Ambulance trip from a diagnostic or therapeutic site other physicians office or hospital to a residential, domiciliary, custodial facility |
| DG | I | Inactive | Ambulance trip from a diagnostic or therapeutic site other physicians office or hospital to a hospital-based dialysis facility |
| DH | I | Inactive | Ambulance trip from a diagnostic or therapeutic site other physicians office or hospital to a hospital |
| DI | I | Inactive | Ambulance trip from a diagnostic or therapeutic site other physicians office or hospital to a site of transfer between ttypes of ambulance |
| DJ | I | Inactive | Ambulance trip from a diagnostic or therapeutic site other physicians office or hospital to a non-hospital-based dialysis facility |
| DN | I | Inactive | Ambulance trip from a diagnostic or therapeutic site other physicians office or hospital to a skilled nursing facility (snf) |
| DP | I | Inactive | Ambulance trip from a diagnostic or therapeutic site other physicians office or hospital to a physicians office |
| DR | I | Inactive | Disaster related (facility claims) |
| DS | I | Inactive | Ambulance trip from a diagnostic or therapeutic site other physicians office or hospital to a scene of accident or acute event |
| DX | I | Inactive | Ambulance from a diagnostic or therapeutic site other physicians office or hosptl to an intrmdiate stop at a physicians office on the way to hosptl |
| E1 | N | NCCI | Upper left, eyelid |
| E2 | N | NCCI | Lower left, eyelid |
| E3 | N | NCCI | Upper right, eyelid |
| E4 | N | NCCI | Lower right, eyelid |
| EA | U | Not Used | Erythropoetic stimulating agent (ESA) administered to treat anemia due to anti-cancer chemotherapy |
| EB | U | Not Used | Erythropoetic stimulating agent (ESA) administered to treat anemia due to anti-cancer radiotherapy |
| EC | U | Not Used | Erythropoetic stimulating agent (ESA) administered to treat anemia not due to anti-cancer radiotherapy or anti-cancer chemotherapy |
| ED | U | Not Used | Hematocrit 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 |
| EE | U | Not Used | Hematocrit 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 |
| EG | I | Inactive | Ambulance trip from a residential, domiciliary, custodial facility to a hospital-based dialysis facility |
| EH | I | Inactive | Ambulance trip from a residential, domiciliary, custodial facility to a hospital |
| EI | I | Inactive | Ambulance trip from a residential, domiciliary, custodial facility to a site of transfer betweentypes of ambulance |
| EJ | U | Not Used | Subsequent claims for a defined course of therapy, e.g., epo, sodium hyaluronate, infliximab |
| EM | U | Not Used | Emergency reserve supply (for ESRD benefit only) |
| EN | I | Inactive | Residential/domiciliary/custodial facility/nursing home - > skilled nursing facility |
| EP | P | Pricing | Service provided as part of Medicaid early periodic screening diagnosis and treatment (EPSDT) program |
| ER | U | Not Used | Items and services furnished by a provider-based, off-campus emergency department |
| ES | I | Inactive | Ambulance trip from a residential, domiciliary, custodial facility to a scene of accident of acute event |
| ET | U | Not Used | Emergency services |
| EX | U | Not Used | Expatriate beneficiary |
| EY | U | Not Used | No physician or other licensed health care provider order for this item or service |
| F1 | N | NCCI | Left hand, second digit |
| F2 | N | NCCI | Left hand, third digit |
| F3 | N | NCCI | Left hand, fourth digit |
| F4 | N | NCCI | Left hand, fifth digit |
| F5 | N | NCCI | Right hand, thumb |
| F6 | N | NCCI | Right hand, second digit |
| F7 | N | NCCI | Right hand, third digit |
| F8 | N | NCCI | Right hand, fourth digit |
| F9 | N | NCCI | Right hand, fifth digit |
| FA | N | NCCI | Left hand, thumb |
| FB | U | Not Used | Item 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) |
| FC | U | Not Used | Partial credit received for replaced device |
| FP | U | Not Used | Service provided as part of family planning program |
| FQ | U | Not Used | The service was furnished using audio-only communication technology |
| FR | U | Not Used | The supervising practitioner was present through two-way, audio/video communication technology |
| FS | U | Not Used | Split (or shared) evaluation and management visit |
| FT | U | Not Used | Unrelated evaluation and management (E/M) visit on the same day as another E/M visit or during a global procedure (preoperative, postoperative period, or on the same day as the procedure, as applicable). (report when an E/M visit is furnished within the global period but is unrelated, or when one or more additional E/M visits furnished on the same day are unrelated) |
| FX | U | Not Used | X-ray taken using film |
| FY | U | Not Used | X-ray taken using computed radiography technology/cassette-based imaging |
| G0 | U | Not Used | Telehealth services for diagnosis, evaluation, or treatment, of symptoms of an acute stroke |
| G1 | U | Not Used | Most recent URR reading of less than 60 |
| G2 | U | Not Used | Most recent URR reading of 60 to 64.9 |
| G3 | U | Not Used | Most recent URR reading of 65 to 69.9 |
| G4 | U | Not Used | Most recent URR reading of 70 to 74.9 |
| G5 | U | Not Used | Most recent URRr reading of 75 or greater |
| G6 | U | Not Used | ESRD patient for whom less than six dialysis sessions have been provided in a month |
| G7 | U | Not Used | Pregnancy resulted from rape or incest or pregnancy certified by physician as life threatening |
| G8 | U | Not Used | Monitored anesthesia care (MAC) for deep complex, complicated, or markedly invasive surgical procedure |
| G9 | U | Not Used | Monitored anesthesia care for patient who has history of severe cardio-pulmonary condition |
| GA | U | Not Used | Waiver of liability statement issued as required by payer policy, individual case |
| GB | U | Not Used | Claim being re-submitted for payment because it is no longer covered under a global payment demonstration |
| GC | U | Not Used | This service has been performed in part by a resident under the direction of a teaching physician |
| GD | U | Not Used | Units of service exceeds medically unlikely edit value and represents reasonable and necessary services |
| GE | P | Pricing | This service has been performed by a resident without the presence of a teaching physician under the primary care exception |
| GF | U | Not Used | Non-physician (e.g. nurse practitioner (NP), certified registered nurse anesthetist (CRNA), certified registered nurse (CRN), clinical nurse specialist (NS), physician assistant (PA)) services in a critical access hospital |
| GG | U | Not Used | Performance and payment of a screening mammogram and diagnostic mammogram on the same patient, same day |
| GH | U | Not Used | Diagnostic mammogram converted from screening mammogram on same day |
| GI | I | Inactive | Ambulance trip from a hospital-based dialysis facility to a site of transfer between types of ambulance |
| GJ | U | Not Used | Opt out physician or practitioner emergency or urgent service |
| GK | U | Not Used | Reasonable and necessary item/service associated with a ga or gz modifier |
| GL | U | Not Used | Medically unnecessary upgrade provided instead of non-upgraded item, no charge, no advance beneficiary notice (ABN) |
| GM | P | Pricing | Multiple patients on one ambulance trip |
| GN | U | Not Used | Services delivered under an outpatient speech language pathology plan of care |
| GO | U | Not Used | Services delivered under an outpatient occupational therapy plan of care |
| GP | U | Not Used | Services delivered under an outpatient physical therapy plan of care |
| GQ | P | Pricing | Via asynchronous telecommunications system |
| GR | U | Not Used | This 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 |
| GS | U | Not Used | Dosage of erythropoietin stimulating agent has been reduced and maintained in response to hematocrit or hemoglobin level |
| GT | Q | Pricing/Reporting | Via interactive audio and video telecommunication systems |
| GU | U | Not Used | Waiver of liability statement issued as required by payer policy, routine notice |
| GV | U | Not Used | Attending physician not employed or paid under arrangement by the patient's hospice provider |
| GW | U | Not Used | Service not related to the hospice patient's terminal condition |
| GX | U | Not Used | Notice of liability issued, voluntary under payer policy |
| GY | U | Not Used | Item or service statutorily excluded, does not meet the definition of any medicare benefit or, for non-medicare insurers, is not a contract benefit |
| GZ | U | Not Used | Item or service expected to be denied as not reasonable and necessary |
| H9 | P | Pricing | Court-ordered |
| HA | P | Pricing | Child/adolescent program (TCM and CPR) |
| HB | P | Pricing | Adult program non-geriatric |
| HC | P | Pricing | Adult program geriatric |
| HD | P | Pricing | Ground ambulance transport from one hospital to another hospital or medical facility for specialized testing and/or treatment/Pregnant/parenting women's program |
| HE | P | Pricing | Mental health program |
| HF | U | Not Used | Substance abuse program |
| HG | U | Not Used | Opioid addiction treatment program |
| HH | P | Pricing | Integrated mental health/substance abuse program (CPR and CSTAR) (ambulance trip hospital to hospital) |
| HI | P | Pricing | Integrated mental health and intellectual disability/developmental disabilities program |
| HJ | U | Not Used | Employee assistance program |
| HK | P | Pricing | Specialized mental health programs for high-risk populations (Therapeutic Day Treatment) (CPR) (EBP for Trauma) |
| HL | P | Pricing | Intern |
| HM | P | Pricing | Less than bachelor degree level |
| HN | P | Pricing | Bachelors degree level |
| HO | P | Pricing | Masters degree level |
| HP | U | Not Used | Doctoral level |
| HQ | P | Pricing | Group setting |
| HR | U | Not Used | Family/couple with client present |
| HS | U | Not Used | Family/couple without client present |
| HT | U | Not Used | Multi-disciplinary team |
| HU | U | Not Used | Funded by child welfare agency |
| HV | U | Not Used | Funded state addiction agency |
| HW | P | Pricing | Funded by state mental health agency (Autism Waiver) |
| HX | P | Pricing | Funded by county/local agency (Partnership for Hope Waiver) |
| HY | U | Not Used | Funded by juvenile justice agency |
| HZ | U | Not Used | Funded by criminal justice agency |
| ID | I | Inactive | Ambulance trip from a site of transfer to a diagnostic or therapeutic site |
| IE | I | Inactive | Ambulance trip from a site of transfer to a residential, domiciliary, custodial facility |
| IG | I | Inactive | Ambulance trip from a site of transfer to a hospital-based dialysis facility |
| IH | I | Inactive | Ambulance trip from a site of transfer to a hospital |
| IJ | I | Inactive | Ambulance trip from a site of transfer to a non-hospital-based dialysis facility |
| IN | I | Inactive | Ambulance trip from a site of transfer to a skilled nursing facility (snf) |
| IP | I | Inactive | Ambulance trip from a site of transfer to a physicians office |
| IR | I | Inactive | Ambulance trip from a site of transfer to a participants residence |
| IS | I | Inactive | Ambulance trip from a site of transfer to a scene of accident or acute event |
| IX | I | Inactive | Ambulance trip from a site of transfer to an intermediate stop at physicians office on the way to the hospital |
| J1 | U | Not Used | Competitive acquisition program no-pay submission for a prescription number |
| J2 | U | Not Used | Competitive acquisition program, restocking of emergency drugs after emergency administration |
| J3 | U | Not Used | Competitive acquisition program (CAP), drug not available through CAP as written, reimbursed under average sales price methodology |
| J4 | U | Not Used | DMEPOS item subject to DMEPOS competitive bidding program that is furnished by a hospital upon discharge |
| J5 | U | Not Used | Off-the-shelf orthotic subject to DMEPOS competitive bidding program that is furnished as part of a physical therapist or occupational therapist professional service |
| JA | U | Not Used | Administered intravenously |
| JB | U | Not Used | Administered subcutaneously |
| JC | U | Not Used | Skin substitute used as a graft |
| JD | U | Not Used | Skin substitute not used as a graft |
| JE | U | Not Used | Administered via dialysate |
| JF | U | Not Used | Compounded drug |
| JG | Q | Pricing/Reporting | Drug or biological acquired with 340b drug pricing program discount, reported for informational purposes |
| JH | I | Inactive | Ambulance trip from a non-hospital-based dialysis facility to a hospital |
| JI | I | Inactive | Ambulance trip from a non-hospital-based dialysis facility to a site of transfer between types of ambulance |
| JK | U | Not Used | One month supply or less of drug or biological |
| JL | U | Not Used | Three month supply of drug or biological |
| JN | I | Inactive | Ambulance trip from a non-hospital-based dialysis facility to a skilled nursing facility (snf) |
| JP | I | Inactive | Ambulance trip from a non-hospital-based dialysis facility to a physicians office |
| JR | I | Inactive | Ambulance trip from a non-hospital-based dialysis facility to a participants residence |
| JS | I | Inactive | Ambulance trip from a non-hospital-based dialysis facility to a scene of accident or acute event |
| JW | U | Not Used | Drug amount discarded/not administered to any patient |
| JX | I | Inactive | Ambulance trip from a non-hospital-based dialysis facility to a intermediate stop at physicians office on the way to the hospital |
| JZ | U | Not Used | Zero drug amount discarded/not administered to any patient |
| K0 | U | Not Used | Lower 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. |
| K1 | U | Not Used | Lower 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 |
| K2 | U | Not Used | Lower 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 |
| K3 | U | Not Used | Lower 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 |
| K4 | U | Not Used | Lower 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 |
| KA | U | Not Used | Add on option/accessory for wheelchair |
| KB | U | Not Used | Beneficiary requested upgrade for abn, more than 4 modifiers identified on claim |
| KC | U | Not Used | Replacement of special power wheelchair interface |
| KD | U | Not Used | Drug or biological infused through dme |
| KE | U | Not Used | Bid under round one of the dmepos competitive bidding program for use with non-competitive bid base equipment |
| KF | U | Not Used | Item designated by fda as class iii device |
| KG | U | Not Used | DMEPOS item subject to DMEPOS competitive bidding program number 1 |
| KH | U | Not Used | DMEPOS item, initial claim, purchase or first month rental |
| KI | U | Not Used | DMEPOS item, second or third month rental |
| KJ | P | Pricing | Dmepos item, parenteral enteral nutrition (pen) pump or capped rental, months four to fifteen |
| KK | U | Not Used | DMEPOS item subject to DMEPOS competitive bidding program number 2 |
| KL | U | Not Used | DMEPOS item delivered via mail |
| KM | U | Not Used | Replacement of facial prosthesis including new impression/moulage |
| KN | U | Not Used | Replacement of facial prosthesis using previous master model |
| KO | U | Not Used | Single drug unit dose formulation |
| KP | U | Not Used | First drug of a multiple drug unit dose formulation |
| KQ | U | Not Used | Second or subsequent drug of a multiple drug unit dose formulation |
| KR | U | Not Used | Rental item, billing for partial month |
| KS | U | Not Used | Glucose monitor supply for diabetic beneficiary not treated with insulin |
| KT | U | Not Used | Beneficiary resides in a competitive bidding area and travels outside that competitive bidding area and receives a competitive bid item |
| KU | U | Not Used | DMEPOS item subject to dmepos competitive bidding program number 3 |
| KV | U | Not Used | DMEPOS item subject to dmepos competitive bidding program that is furnished as part of a professional service |
| KW | U | Not Used | DMEPOS item subject to dmepos competitive bidding program number 4 |
| KX | U | Not Used | Requirements specified in the medical policy have been met |
| KY | U | Not Used | DMEPOS item subject to dmepos competitive bidding program number 5 |
| KZ | U | Not Used | New coverage not implemented by managed care |
| L1 | U | Not Used | Provider attestation that the hospital laboratory test(s) is not packaged under the hospital opps |
| LC | N | NCCI | Left circumflex coronary artery |
| LD | N | NCCI | Left anterior descending coronary artery |
| LL | U | Not Used | Lease/rental (use the 'll' modifier when dme equipment rental is to be applied against the purchase price) |
| LM | N | NCCI | Left main coronary artery |
| LR | U | Not Used | Laboratory round trip |
| LS | U | Not Used | FDA-monitored intraocular lens implant |
| LT | C | NCCI/Pricing | Left side (used to identify procedures performed on the left side of the body) |
| LU | U | Not Used | Fractionated payment |
| M2 | U | Not Used | Medicare secondary payer (MSP) |
| MA | U | Not Used | Ordering 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 |
| MB | U | Not Used | Ordering professional is not required to consult a clinical decision support mechanism due to the significant hardship exception of insufficient internet access |
| MC | U | Not Used | Ordering 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 |
| MD | U | Not Used | Ordering professional is not required to consult a clinical decision support mechanism due to the significant hardship exception of extreme and uncontrollable circumstances |
| ME | U | Not Used | The order for this service adheres to appropriate use criteria in the clinical decision support mechanism consulted by the ordering professional |
| MF | U | Not Used | The order for this service does not adhere to the appropriate use criteria in the clinical decision support mechanism consulted by the ordering professional |
| MG | U | Not Used | The order for this service does not have applicable appropriate use criteria in the qualified clinical decision support mechanism consulted by the ordering professional |
| MH | U | Not Used | Unknown if ordering professional consulted a clinical decision support mechanism for this service, related information was not provided to the furnishing professional or provider |
| MS | U | Not Used | Six month maintenance and servicing fee for reasonable and necessary parts and labor which are not covered under any manufacturer or supplier warranty |
| N1 | U | Not Used | Group 1 oxygen coverage criteria met |
| N2 | U | Not Used | Group 2 oxygen coverage criteria met |
| N3 | U | Not Used | Group 3 oxygen coverage criteria met |
| NB | U | Not Used | Nebulizer system, any type,FDA-cleared for use with specific drug |
| ND | I | Inactive | Ambulance trip from a skilled nursing faciity (snf) to a diagnostic or therapeutic site |
| NE | I | Inactive | Skilled nursing facility -> residential/domiciliary/custodial facility/nursing home |
| NG | I | Inactive | Ambulance trip from a skilled nursing faciity (snf) to a hospital-based dialysis facility |
| NH | I | Inactive | Ambulance trip from a skilled nursing faciity (snf) to a hospital |
| NI | I | Inactive | Ambulance trip from a skilled nursing faciity (snf) to a site of transfer between types of ambulance |
| NJ | I | Inactive | Ambulance trip from a skilled nursing faciity (snf) to a non-hospital-based dialysis facility |
| NN | P | Pricing | Ambulance trip from physician's office to patient's residence |
| NP | I | Inactive | Ambulance trip from a skilled nursing faciity (snf) to a physicians office |
| NR | P | Pricing | New when rented (use the 'NR' modifier when DME which was new at the time of rental is subsequently purchased) |
| NS | I | Inactive | Ambulance trip from a skilled nursing faciity (snf) to a scene of accident of acute event |
| NU | R | Routing | New equipment |
| NX | I | Inactive | Ambulance trip from a skilled nursing faciity (snf) to a intermediate stop at physicians office on the way to the hospi tal |
| P1 | U | Not Used | A normal healthy patient |
| P2 | U | Not Used | A patient with mild systemic disease |
| P3 | U | Not Used | A patient with severe systemic disease |
| P4 | U | Not Used | A patient with severe systemic disease that is a constant threat to life |
| P5 | U | Not Used | A moribund patient who is not expected to survive without the operation |
| P6 | U | Not Used | A declared brain-dead patient whose organs are being removed for donor purposes |
| PA | U | Not Used | Surgical or other invasive procedure on wrong body part |
| PB | U | Not Used | Surgical or other invasive procedure on wrong patient |
| PC | U | Not Used | Wrong surgery or other invasive procedure on patient |
| PD | U | Not Used | Diagnostic 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 |
| PE | I | Inactive | Ambulance trip from a physicians office to a re sidential, domiciliary, custodial facility |
| PG | I | Inactive | Ambulance trip from a physicians office to a ho spital-based dialysis facility |
| PH | I | Inactive | Ambulance trip from a physicians office to a ho spital |
| PI | U | Not Used | 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 |
| PJ | I | Inactive | Ambulance trip from a physicians office to a no n-hospital-based dialysis facility |
| PL | U | Not Used | Progressive addition lenses |
| PM | U | Not Used | Post mortem |
| PN | U | Not Used | Non-excepted service provided at an off-campus, outpatient, provider-based department of a hospital |
| PO | U | Not Used | Excepted off-campus service |
| PR | I | Inactive | Ambulance trip from physician's office to patient's residence |
| PS | U | Not Used | 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 |
| PT | U | Not Used | Colorectal cancer screening test; converted to diagnostic test or other procedure |
| PX | I | Inactive | Ambulance trip from a physicians office to a in termediate stop at physicians office on the way to the hospital |
| Q0 | U | Not Used | Investigational clinical service provided in a clinical research study that is in an approved clinical research study |
| Q1 | U | Not Used | Routine clinical service provided in a clinical research study that is in an approved clinical research study |
| Q2 | R | Routing | Demonstration procedure/service |
| Q3 | U | Not Used | Live kidney donor surgery and related services |
| Q4 | U | Not Used | Service for ordering/referring physician qualifies as a service exemption |
| Q5 | U | Not Used | Service 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 |
| Q6 | U | Not Used | Service 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 |
| Q7 | U | Not Used | One class a finding |
| Q8 | U | Not Used | Two class b findings |
| Q9 | U | Not Used | One class b and two class c findings |
| QA | U | Not Used | Prescribed 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) |
| QB | U | Not Used | Prescribed 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 |
| QC | U | Not Used | Single channel monitoring |
| QD | U | Not Used | Recording and storage in solid state memory by a digital recorder |
| QE | U | Not Used | Prescribed amount of stationary oxygen while at rest is less than 1 liter per minute (LPM) |
| QF | P | Pricing | Prescribed amount of stationary oxygen while at rest exceeds 4 liters per minute (LPM) and portable oxygen is prescribed |
| QG | P | Pricing | Prescribed amount of stationary oxygen while at rest is greater than 4 liters per minute (LPM) |
| QH | U | Not Used | Oxygen conserving device is being used with an oxygen delivery system |
| QJ | U | Not Used | 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) |
| QK | R | Routing | Medical direction of two, three, or four concurrent anesthesia procedures involving qualified individuals |
| QL | U | Not Used | Patient pronounced dead after ambulance called |
| QM | U | Not Used | Ambulance service provided under arrangement by a provider of services |
| QN | U | Not Used | Ambulance service furnished directly by a provider of services |
| QP | U | Not Used | Documentation 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. |
| QQ | U | Not Used | Ordering professional consulted a qualified clinical decision support mechanism for this service and the related data was provided to the furnishing professional |
| QR | U | Not Used | Prescribed 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) |
| QS | U | Not Used | Monitored anesthesia care service |
| QT | U | Not Used | Recording and storage on tape by an analog tape recorder |
| QU | I | Inactive | Md providing svc urban hpsa |
| QW | U | Not Used | CLIA waived test |
| QX | R | Routing | CRNA service: with medical direction by a physician |
| QY | U | Not Used | Medical direction of one certified registered nurse anesthetist (CRNA) by an anesthesiologist |
| QZ | R | Routing | CRNA service: without medical direction by a physician |
| RA | U | Not Used | Replacement of a DME, orthotic or prosthetic item |
| RB | R | Routing | Replacement of a part of a DME, orthotic or prosthetic item furnished as part of a repair |
| RC | N | NCCI | Right coronary artery |
| RD | U | Not Used | Drug provided to beneficiary, but not administered incident-to |
| RE | U | Not Used | Furnished in full compliance with fda-mandated risk evaluation and mitigation strategy (REMS) |
| RG | I | Inactive | Ambulance trip from a residence to a hospital-based dialysis facility |
| RH | I | Inactive | Ambulance trip from the residence to a hospital |
| RI | N | NCCI | Ramus intermedius coronary artery |
| RJ | I | Inactive | Ambulance trip from a residence to a non-hospital-based dialysis facility |
| RN | I | Inactive | Ambulance trip from a residence to a skilled nursing facility (snf) |
| RP | I | Inactive | Replacement and repair (required for dme service) |
| RR | R | Routing | Rental (use the 'RR' modifier when DME is to be rented) |
| RS | I | Inactive | Ambulance trip from a residence to a scene of accident or acute event |
| RT | C | NCCI/Pricing | Right side (used to identify procedures performed on the right side of the body) |
| RX | I | Inactive | Ambulance trip from patient's residence w/intermediate stop at physician's office on way to hospital |
| SA | Q | Pricing/Reporting | Nurse practitioner rendering service in collaboration with a physician |
| SB | U | Not Used | Nurse midwife |
| SC | P | Pricing | Medical necessity service or supply |
| SD | P | Pricing | S - Scene of accident or acute event, to D-Diagnostic or therapeutic site, effective date 1/1/2026 |
| SE | R | Routing | State and/or federally-funded programs/services |
| SF | U | Not Used | Second opinion ordered by a professional review organization (pro) per section 9401, p.l. 99-272 (100% reimbursement - no medicare deductible or coinsurance) |
| SG | R | Routing | Ambulatory surgical center (ASC) facility service |
| SH | U | Not Used | Second concurrently administered infusion therapy |
| SI | I | Inactive | Ambulance trip from the scene of accident or acute event to a site of transfer between types of ambulance |
| SJ | U | Not Used | Third or more concurrently administered infusion therapy |
| SK | U | Not Used | Member of high risk population (use only with codes for immunization) |
| SL | P | Pricing | State supplied vaccine |
| SM | U | Not Used | Second surgical opinion |
| SN | U | Not Used | Third surgical opinion |
| SP | I | Inactive | Nh or snf visit, single patient seen or ambulance trip from the scene of accident or acute event to a physicians office |
| SQ | U | Not Used | Item ordered by home health |
| SR | I | Inactive | Ambulance trip from the scene of accident or acute event to a residence |
| SS | U | Not Used | Home infusion services provided in the infusion suite of the iv therapy provider |
| ST | P | Pricing | Related to trauma or injury |
| SU | P | Pricing | Procedure performed in physician's office (to denote use of facility and equipment) |
| SV | U | Not Used | Pharmaceuticals delivered to patient's home but not utilized |
| SW | U | Not Used | Services provided by a certified diabetic educator |
| SX | I | Inactive | Ambulance trip from the scene of accident or acute event to a intermediate stop at physicians office on the way to the hospital |
| SY | U | Not Used | Persons who are in close contact with member of high-risk population (use only with codes for immunization) |
| SZ | U | Not Used | Habilitative services |
| T1 | N | NCCI | Left foot, second digit |
| T2 | N | NCCI | Left foot, third digit |
| T3 | N | NCCI | Left foot, fourth digit |
| T4 | N | NCCI | Left foot, fifth digit |
| T5 | N | NCCI | Right foot, great toe |
| T6 | N | NCCI | Right foot, second digit |
| T7 | N | NCCI | Right foot, third digit |
| T8 | N | NCCI | Right foot, fourth digit |
| T9 | N | NCCI | Right foot, fifth digit |
| TA | N | NCCI | Left foot, great toe |
| TB | R | Routing | Drug or biological acquired with 340b drug pricing program discount, reported for informational purposes |
| TC | R | Routing | Technical 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 |
| TD | P | Pricing | RN |
| TE | P | Pricing | LPN/LVN |
| TF | P | Pricing | Intermediate level of care |
| TG | P | Pricing | Complex/high tech level of care |
| TH | P | Pricing | Obstetrical treatment/services, prenatal or postpartum |
| TJ | R | Routing | Program group, child and/or adolescent |
| TK | U | Not Used | Extra patient or passenger, non-ambulance |
| TL | P | Pricing | Early intervention/individualized family service plan (IFSP) |
| TM | P | Pricing | Individualized education program (IEP) |
| TN | P | Pricing | Rural/outside providers' customary service area |
| TP | U | Not Used | Medical transport, unloaded vehicle |
| TQ | U | Not Used | Basic life support transport by a volunteer ambulance provider |
| TR | P | Pricing | School-based individualized education program (IEP) services provided outside the public school district responsible for the student |
| TS | P | Pricing | Follow-up service |
| TT | P | Pricing | Individualized service provided to more than one patient in same setting |
| TU | U | Not Used | Special payment rate, overtime |
| TV | U | Not Used | Special payment rates, holidays/weekends |
| TW | P | Pricing | Back-up equipment |
| U1 | P | Pricing | Community support waiver |
| U2 | P | Pricing | Consumer-directed |
| U3 | P | Pricing | Residential care facility (RCF) setting |
| U4 | P | Pricing | AIDS waiver |
| U5 | P | Pricing | Medically fragile adult waiver (MFAW) M/caid care lev 5 state def (Medically Fragile Adult Waiver (MFAW) |
| U6 | P | Pricing | M/caid care lev 6 state def M/caid care lev 6 state def (Independent Living (IL) waiver) |
| U7 | P | Pricing | Sexual Assault Findings Examination (SAFE) and Child Abuse Resources Examination (CARE) network services |
| U8 | P | Pricing | Service provided in home setting |
| U9 | P | Pricing | Diabetes self-management training services |
| UA | P | Pricing | Environmental lead related service |
| UB | P | Pricing | Exception process service |
| UC | R | Routing | Epsdt referral for follow-up care (required if EPSDT referral made) |
| UD | P | Pricing | M/caid care lev 13 state def (Missouri defined as: Licensed Professional Counselor) |
| UE | U | Not Used | Used durable medical equipment |
| UF | U | Not Used | Services provided in the morning |
| UG | U | Not Used | Services provided in the afternoon |
| UH | U | Not Used | Services provided in the evening |
| UJ | U | Not Used | Services provided at night |
| UK | P | Pricing | Services provided on behalf of the client to someone other than the client (collateral relationship) |
| UN | U | Not Used | Two patients served |
| UP | U | Not Used | Three patients served |
| UQ | U | Not Used | Four patients served |
| UR | U | Not Used | Five patients served |
| US | U | Not Used | Six or more patients served |
| V1 | U | Not Used | Demonstration modifier 1 |
| V2 | U | Not Used | Demonstration modifier 2 |
| V3 | U | Not Used | Demonstration modifier 3 |
| V4 | U | Not Used | Demonstration modifier 4 |
| V5 | U | Not Used | Vascular catheter (alone or with any other vascular access) |
| V6 | U | Not Used | Arteriovenous graft (or other vascular access not including a vascular catheter) |
| V7 | U | Not Used | Arteriovenous fistula only (in use with two needles) |
| V8 | U | Not Used | Infection present |
| V9 | U | Not Used | No infection present |
| VM | U | Not Used | Medicare Diabetes Prevention Program (MDPP) virtual make-up session |
| VP | U | Not Used | Aphakic patient |
| W1 | I | Inactive | Office surgical procedure physician 's office |
| W2 | L | Internal | Outpatient podiatry |
| W3 | I | Inactive | Asc pedodontic restoration over 150 minutes |
| W4 | I | Inactive | Community psych. rehab. (tos l, prov type 87) or health department immunizations (prov. type 51) |
| W5 | I | Inactive | Dental procedures |
| W6 | I | Inactive | Dental procedures |
| W7 | I | Inactive | Professional component |
| W8 | I | Inactive | Technical component |
| W9 | I | Inactive | Dental procedures |
| WO | I | Inactive | Child abuse resource education (care) exam.[to be used with w1350 sexual abuse findings examination |
| WQ | I | Inactive | Individual educational plan (iep)/individual family service plan (ifsp) |
| WR | I | Inactive | Continuous ambulatory peritoneal dialysis (capd) - home (only use with procedure code 90945) |
| X1 | U | Not Used | Continuous/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 |
| X2 | U | Not Used | Continuous/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 |
| X3 | U | Not Used | Episodic/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 |
| X4 | U | Not Used | Episodic/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 |
| X5 | U | Not Used | Diagnostic 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 |
| XA | I | Inactive | Local code no longer used |
| XB | I | Inactive | Local code no longer used |
| XC | I | Inactive | Complete medical screening |
| XD | I | Inactive | Complete medical screening with referral |
| XE | N | NCCI | Separate encounter, a service that is distinct because it occurred during a separate encounter |
| XF | I | Inactive | Developmental/mental health partial screen with referral |
| XG | I | Inactive | Local code no longer used |
| XH | I | Inactive | Local code no longer used |
| XI | I | Inactive | Unclothed physical and history screening |
| XJ | I | Inactive | Unclothed physical and history screening with referral |
| XK | I | Inactive | Dental screening |
| XL | I | Inactive | Dental screening with referral |
| XM | I | Inactive | Vision screening |
| XN | I | Inactive | Vision screening with referral |
| XP | N | NCCI | Separate practitioner, a service that is distinct because it was performed by a different practitioner |
| XQ | I | Inactive | Hearing screening with referral |
| XR | I | Inactive | Local code no longer used |
| XS | N | NCCI | Separate structure, a service that is distinct because it was performed on a separate organ/structure |
| XU | N | NCCI | Unusual non-overlapping service, the use of a service that is distinct because it does not overlap usual components of the main service |
| YA | I | Inactive | Physician/dental/podiatry injections |
| YB | I | Inactive | Physician/dental/podiatry injections |
| YC | I | Inactive | Physician/dental/podiatry injections |
| YD | I | Inactive | Physician/dental/podiatry injections |
| YE | I | Inactive | Physician/dental/podiatry injections |
| YF | I | Inactive | Psychiatric nurse services |
| YG | I | Inactive | Early periodic screening, diagnosis test (epsdt/pediatric services) |
| YH | I | Inactive | Advanced personal care for aids - state plan |
| YJ | I | Inactive | Local code no longer used |
| YK | I | Inactive | Local code no longer used |
| Z1 | I | Inactive | Hiv test/post-test counseling |
| Z2 | I | Inactive | Std test/post-test counseling |
| Z3 | I | Inactive | Tb test/post-test counseling |
| ZA | U | Not Used | Novartis/sandoz |
| ZB | U | Not Used | Pfizer/hospira |
| ZC | U | Not Used | Merck/Samsung Bioepis |
| ZO | I | Inactive | Ambulance out of locale |
| ZZ | I | Inactive | Third opinion |