Modifiers Used with Procedure Codes (modif used)

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Modifiers Used with Procedure Codes

Page updated: February 2021 The following charts list procedure codes with their corresponding required or allowable modifiers. The column headings of the charts are described below.

Service or Procedure

The "Service or Procedure" column lists services according to the categories in the HCPCS and CPT? code books.

Required Modifiers

The "Required Modifiers" column refers to services or procedures that require a split-bill modifier:

? 26: Professional Component ? TC: Technical Component ? 99: Multiple Modifiers. Explain in the Remarks area/Additional Claim Information

(Box 19) of the claim form. For further information about billing with modifier 99, see the Surgery: Billing With Modifiers section in the appropriate Part 2 manual. Note: Do not bill modifier 99 in conjunction with modifier 26 and TC. The claim will be denied. When billing for both the professional and technical service components on a splitbillable claim, a modifier is neither required nor allowed. This change does not apply to Magnetic Resonance Imaging (MRI), Magnetic Resonance Angiography (MRA), and Positron Emission Tomography (PET) codes. Refer to the appropriate sections of the Part 2 provider manual for billing instructions.

Part 2 ? Modifiers Used with Procedure Codes

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Page updated: May 2022

Codes or Code Ranges

The "Codes or Code Ranges" column lists the specific code or range of codes that either require a modifier or may need an allowable modifier for billing. The listed code ranges may include codes that are not benefits of the program or are not payable codes. Therefore, individual codes should be checked against the TAR and Non-Benefit List: Codes 10000 thru 99999, and specific code policy section in the appropriate Part 2 manual.

Allowable Modifiers

The "Allowable Modifiers" column refers to services or procedures that may use certain allowable modifiers to indicate that the procedure or service has been altered by some specific circumstance but not changed in its definition or code. For a list of approved modifiers, refer to the Modifiers: Approved List section in this manual. Some procedures do not need further clarification with a modifier. Use of modifiers other than those listed in the Modifiers: Approved List may result in the claim being denied.

Modifier 33

Modifier 33 (preventive service) is not listed in the following charts as this modifier is allowable for all procedure codes. If used, modifier 33 must not be billed in the first modifier position on the claim.

NCCI-Associated Modifiers

Ophthalmologic Modifiers

For information about modifiers used for ophthalmological services, refer to the Ophthalmology section in the appropriate Part 2 manual.

Telehealth Modifiers GQ and 95

For information about telehealth modifiers GQ and 95, providers may refer to the Medicine: Telehealth section in the appropriate Part 2 manual.

Additional Modifier Information

For further information about required or allowable modifier usage for specific procedure codes, please refer to specific policy sections.

Part 2 ? Modifiers Used with Procedure Codes

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Page updated: December 2022

E&M Codes and Modifiers

Table of Codes and Modifiers

Service or Procedure

Self-Management Education and Training Remote Physiologic Monitoring (E&M) Evaluation and Management (E&M) performed by a Non-physician Medical Practitioner (NMP)

E&M performed by an NMP Office or Other Outpatient Services (E&M) Hospital Inpatient Services (E&M) Consultations

Consultations

Codes or Code Ranges

98960 thru 98962

99091, 99453, 99454, 99457, 99458 99202 thru 99215, , 99238 thru 99499 (See the Non-Physician Medical Practitioners [NMP] section in the appropriate Part 2 manual for more information.) 96125, 99483

99202 thru 99215

99221 thru 99233

, 99256 thru 99275

Required Modifiers None None None

None None None None None

Emergency Department Services (E&M) Critical Care Services (E&M)

99281 thru 99285 99291, 99292

None None

Allowable Modifiers SA, SB, U2, U3, U7, 99 SA, SB, U7, 24, 25, 99 GC, SA, SB, U7, 24, 25, 57, 99

SA, U7, 99 GC, 24, 25, 57

GC, HA, HB, 24, 25, 57 GC, 24, 25, 57

GC, 24, 25, 57, HA, HB GC, 24, 25, 57

GC, 24, 25, 57

Part 2 ? Modifiers Used with Procedure Codes

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Page updated: December 2022

Table of E&M Codes and Modifiers (continued)

Service or Procedure Codes or Code Ranges

Nursing Facility Services (E&M) Domiciliary, Boarding Home or Custodial Care Services (E&M) Home Services (E&M)

Home Assessment

99301 thru 99313

, 99347 thru 99350 99346

Required Modifiers None None

None

None

Medical Team Conference (E&M) Preventive Medicine Services (E&M) Preventive Medicine Services (E&M) Preventive Medicine Services (E&M) Behavior Change Intervention (E&M)

99366, 99368 99381 thru 99397 G0310 thru G0311 G0312 thru G0315 99406, 99407

Supervision of Clinical 99415, 99416 Staff (E&M)

Other Outpatient Service (E&M)

99417

Principle Care Management (E&M)

99424 thru 99427

None None None None None

None

None

None

Allowable Modifiers GC, 24, 25, 57

GC, 24, 25, 57

GC, HA, HB, 24, 25, 57 GC, SA, SB, U3, U7, 24, 25, 57, 99 GN, GO, GP, HA, HB, 99 GC, SA, U7, 24, 25, 57, 99 SA, U7, SB, 99

SA, U7, SB, EP 99 SA, SB, GC, U1, U7, U9, 24, 25, 57, 99 GC, SA, SB, U7, 24, 25, 57 99 GC, SA, SB, U7, 24, 25, 57, 95, 99 GC, SA, U7, 24, 25, 57, 99

Part 2 ? Modifiers Used with Procedure Codes

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Page updated: October 2022

Table of E&M Codes and Modifiers (continued)

Service or Procedure Unlisted Preventive Medicine Service (E&M) Chronic Care Management (E&M)

Unlisted E&M Service

Codes or Code Ranges 99429

99437 99439

Required Modifiers None

None

None

SA, U7, 24, 25, 99 GC, 24, 25, 57 SA, U7, 99

HCPCS, CPT Medicine Codes and Modifiers

Table of Codes and Modifiers

Service or Procedure Codes or Code Ranges

Anesthesia

01937 thru 01942

Required Modifiers None

Allowable Modifiers AA, AG, ET, P1, P3, P4, P5, PA, PB, PC, QK, QS, QX, QY, QZ, UB, U7, 22, 99

Part 2 ? Modifiers Used with Procedure Codes

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