Additional HCPCS modifiers

Modifier	Description
AB	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 maybe performed once every 12 months, per beneficiary.
AE	Registered dietician.
AF	Specialty physician.
AG	Primary physician.
AI	Principal physician of record.
AK	Non-participating physician.
AM	Physician, team member service.
AO	Alternative payment method declined by a provider of service.
AT	Acute treatment. Chiropractors must bill the AT modifier when reporting HCPCS codes 98940, 98941, 98942 to indicate active / corrective treatment. Claims submitted without the AT modifier will be denied for maintenance therapy. Note: Effective with claims received on and after September 13, 2021, the AT modifier is no longer required on tetanus or rabies injection(s).
AZ	Physician providing a service in a dental health professional shortage area for the purpose of a promoting interoperability (PI) payment (formerly EHR Incentive payment).
BL	Special acquisition of blood and blood products.
CA	Procedure payable only in the inpatient setting when performed emergently on an outpatient who expires prior to admission.
CB	Services ordered by a dialysis physician, as part of the ESRD beneficiary’s dialysis benefit, are not part of the composite rate and separately reimbursable. Note: Effective with dates of service on or after July 1, 2019, this modifier is no longer reported by independent laboratories requesting separate payment outside SNF CB for ESRD dialysis-related services.
CG	Policy criteria applied.
CR	Catastrophe / Disaster related. Required when item or service is impacted by emergency or disaster and Medicare payment for such item / service is conditioned on presence of "formal waiver."
CS	Cost-sharing for specified COVID-19 testing-related services that result in an order for or administration of a COVID-19 test. Note: Cost-sharing does not apply for COVID-19 testing-related services, which are medical visits that: are furnished between March 18, 2020 and the end of the public health emergency (PHE); that result in an order for or administration of a COVID-19 test; are related to furnishing or administering such a test or to the evaluation of an individual for purposes of determining the need for such a test. For claims initially submitted without the CS modifier providers/suppliers must notify their MAC by submitting a claim correction or clerical error reopening.
CT	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	Oral health assessment by a licensed health professional other than a dentist.
ER	Items and services furnished by a provider-based off-campus emergency department. Note: Report this modifier on a UB-04 (CMS-1450) with every claim line for outpatient hospital services furnished in an off-campus provider-based emergency department. Critical access hospitals are not required to report this modifier.
ET	Emergency services
FB	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	Partial credit received for replaced device.
FS	Split or shared E/M visit.
FX	X-ray taken using films.
FY	X-ray taken using computed radiography technology/cassette-based imaging.
G7	Pregnancy resulted from rape or incest or pregnancy certified by physicians as life threatening.
GC	This service has been performed in part by a resident under the direction of a teaching physician.
GE	This service has been performed by a resident without the presence of a teaching physician under the primary care exception. Note: Modifier GE for this purpose, use on all services except ambulance.
GF	Services rendered in a CAH by a nurse practitioner (NP), clinical nurse specialist (CNS) or physician assistant (PA). Modifier GF only applies to Method II/optional providers Note: The GF modifier is not used for a certified registered nurse anesthetist (CRNA), services and will be returned to the provider. There is no benefit under Medicare law that authorizes payment to CRNs for their services. Accordingly, if a claim is received and it has the “GF” modifier for CRN services, no Medicare payment should be made.
GG	Performance and payment of screening mammogram and diagnostic mammogram on the same patient, same day. Note: This modifier is for tracking purposes only.
GJ	Opt-out physician / practitioner emergency or urgent services.
GU	Waiver of liability statement issued as required by a payer policy, routine notice.
J1	Competitive acquisition program, no-pay submission for a prescription number.
J2	Competitive acquisition program, restocking of emergency drugs after emergency administration.
J3	CAP drug not available through CAP as written, reimburse under ASP methodology.
JA	Administered intravenously.
JB	Administered subcutaneously.
JC	Skin substitute used as a graft.
JD	Skin substitute NOT used as a graft.
JG	Drug or biological acquired with 340B drug pricing program discount. Non-excepted off-campus provider-based departments of a hospital paid under the provider fee schedule are required to report modifier this modifier.
JW	Drug / biological discarded / not administered to any patient.
JZ	Zero drug amount discarded/not administered to any patient
KX	Requirements specified in the medical policy have been met
L1	Separate payment for outpatient lab tests under the clinical laboratory fee schedule in the following circumstances: A hospital collects specimen and furnishes only the outpatient labs on a given date of service; or A hospital conducts outpatient lab tests that are clinically unrelated to other hospital outpatient services furnished the same day. Note: “Unrelated” means the laboratory test is ordered by a different practitioner than the practitioner who ordered other hospital outpatient services and for a different diagnosis. Hospitals should no longer use TOB 14X in these circumstances.
LU	Fractionalized payment CAR T-cell therapy This new modifier is in the January 2023 HCPCS update and is effective retroactively for use on claims with dates of service on or after January 1, 2022.
M2	Medicare secondary payer for CAP
PD	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
PI	PET tumor initial treatment strategy
PO	Services, procedures and/or surgeries furnished at off-campus provider-based outpatient departments. Report this modifier with every code for outpatient hospital services furnished in an off-campus provider-based outpatient department of a hospital.
PN	Non-excepted service provided at an off-campus, outpatient, provider-based department of a hospital
PS	PET tumor subsequent treatment strategy
PT	Colorectal cancer screening test; converted to diagnostic test or other procedure
Q0	Investigational clinical service provided in a clinical research study that is in an approved clinical research study.
Q1	Routine clinical service provided in a clinical research study that is in an approved clinical research study.
Q3	Live kidney donor surgery and related services Services will be reimbursed at 100% of the allowed charge as required in Section 1881 (d) of the Social Security Act. The following bullets are some reporting notes and tips for submitting kidney donor services: If more than two modifiers are required when reporting postoperative physician services furnished to live kidney donors, it is important that the Q3 modifier is reported in the first modifier position. This is necessary to ensure that these services are reimbursed at 100%. Services are to be reported under the name and Medicare Beneficiary ID number of the recipient of the kidney donation. Procedure code 50320, donor nephrectomy from living donor 50547.
Q4	Service for ordering / referring physician qualifies as a service exemption for laboratory services.
Q5	Service furnished by a substitute physician under a reciprocal billing arrangement.
Q6	Service furnished by a locum tenens physician.
QJ	Services/items provided to a prisoner or patient in state or local custody, however the state or local government, as applicable, meets the requirements in 42 CFR 411. 4 (b)
QQ	Ordering professional consulted a qualified clinical decision support mechanism for this service and the related data was provided to the furnishing professional.
RD	Drug provided to beneficiary, but not, administrated incident-to.
RE	Furnished in full compliance with FDA-mandated REMS (risk evaluation and mitigation strategy).
SC	Medically necessary service or supply.
SF	Second opinion ordered by a Professional Review Organization per section 9401, P.L. 99-272 (100 % reimbursement – no Medicare deductible or coinsurance).
SS	Home infusion services provided in the infusion suite of the IV therapy provider.
SW	Services provided by a certified diabetes educator.
TB	Drug or biological acquired with 340B drug pricing program discount, reported for informational purposes. Note: Since rural sole community hospitals, children’s hospitals, and prospective payment system-exempt cancer hospitals are excepted from the 340B payment adjustment, these hospitals will report informational modifier “TB” for 340B-acquired drugs.
TC	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 code number. This modifier must be reported in the first modifier field.
TS	Follow-up service.
UJ	Services provided at night.
UN	Two patients served: This modifier is needed when transportation of portable x-ray equipment (R0075) is billed.
UP	Three patients served: This modifier is needed when transportation of portable X-ray equipment (R0075) is billed.
UQ	Four patients served: This modifier is needed when transportation of portable X-ray equipment (R0075) is billed.
UR	Five patients served: This modifier is needed when transportation of portable X-ray equipment (R0075) is billed.
US	Six patients served: This modifier is needed when transportation of portable X-ray equipment (R0075) is billed.
X1	Continuous/broad services = For reporting services by clinicians who provide the principal care for a patient, with no planned endpoint of the relationship.
X2	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 for a long time.
X3	Episodic/broad services = For reporting services by clinicians who have broad responsibility for the comprehensive needs of the patients, that is limited to a defined period and circumstance, such as a hospitalization.
X4	Episodic/focused services = For reporting services by specialty focused clinicians who provide time-limited care.
X5	Only as ordered by another clinician = For reporting services by a clinician who furnishes care to the patient only as ordered by another clinician.
XE	Separate encounter: A service that is distinct because it occurred during a separate encounter (subset of modifier 59). Note: Only use XE to describe separate encounters on the same date of service
XP	Separate practitioner: A service that is distinct because it was performed by a different practitioner (subset of modifier 59).
XS	Separate structure: A service that is distinct because it was performed on a separate organ / structure (subset of modifier 59).
XU	Unusual non-overlapping service: The use of a service that is distinct because it does not overlap usual components of the main service (subset of modifier 59).