HCPCS Modifiers

Two-character codes appended to HCPCS/CPT codes to indicate special circumstances affecting services.

Modifier Description
A1 Dressing for one wound
A2 Dressing for two wounds
A3 Dressing for three wounds
A4 Dressing for four wounds
A5 Dressing for five wounds
A6 Dressing for six wounds
A7 Dressing for seven wounds
A8 Dressing for eight wounds
A9 Dressing for 9 or more wound
AA Anesthesia perf by anesgst
AB Aud svs w/o order evry 12mo
AD Md supervision, >4 anes proc
AE Registered dietician
AF Specialty physician
AG Primary physician
AH Clinical psychologist
AI Principal physician of rec
AJ Clinical social worker
AK Non participating physician
AM Physician, team member svc
AO Prov declined alt pmt method
AP No dtmn of refractive state
AQ Physician service hpsa area
AR Physician scarcity area
AS Assistant at surgery service
AT Acute treatment
AU Uro, ostomy or trach item
AV Item w prosthetic/orthotic
AW Item w a surgical dressing
AX Item w dialysis services
AY Item/service not for esrd tx
AZ Physician serv in dent hpsa
BA Item w pen services
BL Spec acquisition blood prods
BO Nutrition oral admin no tube
BP Bene electd to purchase item
BR Bene elected to rent item
BU Bene undecided on purch/rent
CA Procedure payable inpatient
CB Esrd bene part a snf-sep pay
CC Procedure code change
CD Amcc test for esrd or mcp md
CE Med neces amcc tst sep reimb
CF Amcc tst not composite rate
CG Policy criteria applied
CH 0 percent impaired, ltd, res
CI 1 to <20 percent impaired
CJ 20 to <40 percent impaired
CK 40 to <60 percent impaired
CL 60 to <80 percent impaired
CM 80 to <100 percent impaired
CN 100 percent impaired, ltd
CO Outpatient ot service by ota
CP C-apc adjunctive service
CQ Outpatient pt service by pta
CR Catastrophe/disaster related
CS Cost share waiver covid-19
CT Ct does not meet nema standa
DA Oral health assess, not dent
E1 Upper left eyelid
E2 Lower left eyelid
E3 Upper right eyelid
E4 Lower right eyelid
EA Esa, anemia, chemo-induced
EB Esa, anemia, radio-induced
EC Esa, anemia, non-chemo/radio
ED Hct>39% or hgb>13g>=3 cycle
EE Hct>39% or hgb>13g<3 cycle
EJ Subsequent claim
EM Emer reserve supply (esrd)
EP Medicaid epsdt program svc
ER Off-campus ed service
ET Emergency services
EX Expatriate beneficiary
EY No md order for item/service
F1 Left hand, second digit
F2 Left hand, third digit
F3 Left hand, fourth digit
F4 Left hand, fifth digit
F5 Right hand, thumb
F6 Right hand, second digit
F7 Right hand, third digit
F8 Right hand, fourth digit
F9 Right hand, fifth digit
FA Left hand, thumb
FB Item provided without cost
FC Part credit, replaced device
FP Svc part of family plan pgm
FQ Audio-only service
FR Two-way a/v dir supervision
FS Split or shared e/m visit
FT Separate, unrelated e/m
FX X-ray taken using film
FY Computed radiography x-ray
G0 Telestroke
G1 Urr reading of less than 60
G2 Urr reading of 60 to 64.9
G3 Urr reading of 65 to 69.9
G4 Urr reading of 70 to 74.9
G5 Urr reading of 75 or greater
G6 Esrd patient <6 dialysis/mth
G7 Payment limits do not apply
G8 Monitored anesthesia care
G9 Mac for at risk patient
GA Liability waiver ind case
GB Claim resubmitted
GC Resident/teaching phys serv
GD Unit of service > mue value
GE Resident prim care exception
GF Nonphysician serv c a hosp
GG Payment screen mam + diagmam
GH Diag mammo to screening mamo
GJ Opt out provider of er srvc
GK Actual item/service ordered
GL Upgraded item, no charge
GM Multiple transports
GN Op speech language service
GO Op occupational therapy serv
GP Op pt services
GQ Telehealth store and forward
GR Service by va resident
GS Epo/darbepoietin reduced 25%
GT Interactivetelecommunication
GU Liability waiver rout notice
GV Attending phys not hospice
GW Service unrelated to term co
GX Voluntary liability notice
GY Statutorily excluded
GZ Not reasonable and necessary
H9 Court-ordered
HA Child/adolescent program
HB Adult program non-geriatric
HC Adult program geriatric
HD Pregnant/parenting program
HE Mental health program
HF Substance abuse program
HG Opioid addiction tx program
HH Mental hlth/substance abs pr
HI Men hlth intel/dev disab pgm
HJ Employee assistance program
HK Spec hgh rsk mntl hlth pop p
HL Intern
HM Less than bachelor degree lv
HN Bachelors degree level
HO Masters degree level
HP Doctoral level
HQ Group setting
HR Family/couple w client prsnt
HS Family/couple w/o client prs
HT Multi-disciplinary team
HU Child welfare agency funded
HV Funded state addiction agncy
HW State mntl hlth agncy funded
HX County/local agency funded
HY Funded by juvenile justice
HZ Criminal justice agncy fund
J1 Cap no-pay for prescript num
J2 Cap restock of emerg drugs
J3 Cap drug unavail thru cap
J4 Dmepos comp bid furn by hosp
J5 Dmepos comp bid fur by pt/ot
JA Administered intravenously
JB Administered subcutaneously
JC Skin substitute graft
JD Skin sub not used as a graft
JE Administered via dialysate
JF Compounded drug
JG 340b acquired drug
JK Drug supply 1 month or less
JL Drug 3 month supply
JW Discarded drug not administe
JZ Zero drug wasted
K0 Lwr ext prost functnl lvl 0
K1 Lwr ext prost functnl lvl 1
K2 Lwr ext prost functnl lvl 2
K3 Lwr ext prost functnl lvl 3
K4 Lwr ext prost functnl lvl 4
KA Wheelchair add-on option/acc
KB >4 modifiers on claim
KC Repl special pwr wc intrface
KD Drug/biological dme infused
KE Bid under round 1 dmepos cb
KF Fda class iii device
KG Dmepos comp bid prgm no 1
KH Dmepos ini clm, pur/1 mo rnt
KI Dmepos 2nd or 3rd mo rental
KJ Dmepos pen pmp or 4-15mo rnt
KK Dmepos comp bid prgm no 2
KL Dmepos mailorder comp bid
KM Rplc facial prosth new imp
KN Rplc facial prosth old mod
KO Single drug unit dose form
KP First drug of multi drug u d
KQ 2nd/subsqnt drg multi drg ud
KR Rental item partial month
KS Glucose monitor supply
KT Item from noncontract supply
KU Dmepos comp bid prgm no 3
KV Dmepos item, profession serv
KW Dmepos comp bid prgm no 4
KX Documentation on file
KY Dmepos comp bid prgm no 5
KZ New cov not implement by m+c
L1 Separately payable lab test
LC Lft circum coronary artery
LD Left ant des coronary artery
LL Lease/rental (appld to pur)
LM Left main coronary artery
LR Laboratory round trip
LS Fda-monitored iol implant
LT Left side
LU Fractionated payment
M2 Medicare secondary payer
MA Emer med cond susp/confirm
MB Auc hardship, insuf internet
MC Auc hardship, vendor issues
MD Auc hardship, extreme circ
ME Order adheres to auc
MF Order does not adhere to auc
MG Auc not applicable to order
MH Auc consult not provided
MS 6-mo maint/svc fee parts/lbr
N1 Group 1 oxygen cov crit met
N2 Group 2 oxygen cov crit met
N3 Group 3 oxygen cov crit met
NB Drug specific nebulizer
NR New when rented
NU New equipment
P1 Normal healthy patient
P2 Patient w/mild syst disease
P3 Patient w/severe sys disease
P4 Pt w/sev sys dis threat life
P5 Pt not expect surv w/o oper
P6 Brain-dead pt organs removed
PA Surgery, wrong body part
PB Surgery, wrong patient
PC Wrong surgery on patient
PD Inp admit w/in 3 days
PI Pet tumor init tx strat
PL Progressive addition lenses
PM Post mortem
PN Non-excepted off-campus svc
PO Excepted off-campus service
PS Pet tumor subsq tx strategy
PT Clrctal screen to diagn
Q0 Invest clinical research
Q1 Routine clinical research
Q2 Demo procedure, service
Q3 Live donor surgery/services
Q4 Svc exempt - ordrg/rfrng md
Q5 Recip bill arr subs md or pt
Q6 Fee/time comp subst md or pt
Q7 One class a finding
Q8 Two class b findings
Q9 1 class b & 2 class c fndngs
QA Avg sta day/night o2 < 1 lpm
QB Avg day/nite o2 > 4 lpm/port
QC Single channel monitoring
QD Rcrdg/strg in sld st memory
QE Stationary o2 @ rest <1 lpm
QF Station o2 @ rest >4lpm/port
QG Station o2 @ rest > 4 lpm
QH Oxygen cnsrvg dvc w del sys
QJ Patient in state/locl custod
QK Med dir 2-4 cncrnt anes proc
QL Patient died after amb call
QM Ambulance arr by provider
QN Ambulance furn by provider
QP Individually ordered lab tst
QQ Qualified cdsm consulted
QR Avg sta day/night o2 > 4 lpm
QS Monitored anesthesia care
QT Rcrdg/strg tape analog recdr
QW Clia waived test
QX Crna svc w/ md med direction
QY Medically directed crna
QZ Crna svc w/o med dir by md
RA Replacement of dme item
RB Replacement part, dme item
RC Right coronary artery
RD Drug admin not incident-to
RE Furnish full compliance rems
RI Ramus intermedius cor artery
RR Rental (dme)
RT Right side
SA Nurse practitioner w physici
SB Nurse midwife
SC Medically necessary serv/sup
SD Serv by home infusion rn
SE State/fed funded program/ser
SF 2nd opinion ordered by pro
SG Asc facility service
SH 2nd concurrent infusion ther
SJ 3rd concurrent infusion ther
SK High risk population
SL State supplied vaccine
SM Second opinion
SN Third opinion
SQ Item ordered by home health
SS Hit in infusion suite
ST Related to trauma or injury
SU Performed in phys office
SV Drugs delivered not used
SW Serv by cert diab educator
SY Contact w/high-risk pop
SZ Habilitative services
T1 Left foot, second digit
T2 Left foot, third digit
T3 Left foot, fourth digit
T4 Left foot, fifth digit
T5 Right foot, great toe
T6 Right foot, second digit
T7 Right foot, third digit
T8 Right foot, fourth digit
T9 Right foot, fifth digit
TA Left foot, great toe
TB 340b drug
TC Technical component
TD Rn
TE Lpn/lvn
TF Intermediate level of care
TG Complex/high tech level care
TH Ob tx/srvcs prenatl/postpart
TJ Child/adolescent program gp
TK Extra patient or passenger
TL Early intervention ifsp
TM Individualized ed prgrm(iep)
TN Rural/out of service area
TP Med transprt unloaded vehicl
TQ Bls by volunteer amb providr
TR School-based iep out of dist
TS Follow-up service
TT Additional patient
TU Overtime payment rate
TV Holiday/weekend payment rate
TW Back-up equipment
U1 M/caid care lev 1 state def
U2 M/caid care lev 2 state def
U3 M/caid care lev 3 state def
U4 M/caid care lev 4 state def
U5 M/caid care lev 5 state def
U6 M/caid care lev 6 state def
U7 M/caid care lev 7 state def
U8 M/caid care lev 8 state def
U9 M/caid care lev 9 state def
UA M/caid care lev 10 state def
UB M/caid care lev 11 state def
UC M/caid care lev 12 state def
UD M/caid care lev 13 state def
UE Used durable med equipment
UF Services provided, morning
UG Services provided, afternoon
UH Services provided, evening
UJ Services provided, night
UK Svc on behalf client-collat
UN Two patients served
UP Three patients served
UQ Four patients served
UR Five patients served
US Six or more patients served
V1 Demonstration modifier 1
V2 Demonstration modifier 2
V3 Demonstration modifier 3
V4 Demonstration modifier 4
V5 Vascular catheter
V6 Arteriovenous graft
V7 Arteriovenous fistula
V8 Infection present
V9 No infection present
VM Mdpp virtual make-up session
VP Aphakic patient
X1 Continuous/broad services
X2 Continuous/focused services
X3 Episodic/broad services
X4 Episodic/focused services
X5 Svc req by another clinician
XE Separate encounter
XP Separate practitioner
XS Separate organ/structure
XU Unusual separate service
ZA Novartis/sandoz
ZB Pfizer/hospira
ZC Merck/samsung bioepis