Modifiers Used with Procedure Codes (modif used)
[Pages:19]modif used 1
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.
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.
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: September 2020
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
The National Correct Coding Initiative (NCCI)-associated modifiers are those modifiers required, in applicable circumstances, to bypass an NCCI edit. Refer to the Correct Coding Initiative: National section for a list of 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 2021
E&M Codes and Modifiers
Table of Codes and Modifiers
Service or Procedure
GC, 24, 25, 57
SA, SB, GC, U7, U9, 24, 25, 57, 99
Part 2 ? Modifiers Used with Procedure Codes
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Page updated: December 2021
Table of E&M Codes and Modifiers (continued)
Service or Procedure Supervision of Clinical Staff (E&M)
Codes or Code Ranges 99415, 99416
Required Modifiers None
Other Outpatient Service (E&M)
99417
None
SA, U7, 24, 25, 57, 99 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
Part 2 ? Modifiers Used with Procedure Codes
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Page updated: December 2021
Table of Codes and Modifiers
Service or Procedure
Genomic Sequencing Rabies Immune Globulins Medicine performed by a Non-Physician Medical Practitioner (NMP) Medicine performed by a Non-Physician Medical Practitioner (NMP)
Vaccines for Children (VFC)
VFC
Codes or Code Ranges
81434 90377
90674
90673, 90700 thru 99199 (See the Non-Physician Medical Practitioners [NMP] section in the Part 2 manual for more information.) 90633, 90647, 90648, 90655 thru 90658, 90660, 90674, 90680, 90685, 90686, 90688, 90700, 90707, 90710, 90713 thru 90716, 90723, 90734, 90743, 90744 90697
Required Modifiers None None None
None
SL
SL
Allowable Modifiers 33, 90, 99 SA, SB, UD, U7, 99 SA, SB, UD, U7, 99
SA, SB, U7, 22, 99
SL (90674 only)
SA, SB, UD, U7, 99
Part 2 ? Modifiers Used with Procedure Codes
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Page updated: December 2021
Table of Codes and Modifiers (continued)
Service or Procedure Codes or Code Ranges
Vaccine for High Risk
Vaccine for High Risk Vaccine for High Risk and VFC Vaccine for High Risk and VFC Vaccine for High Risk and VFC Vaccine for High Risk and VFC Vaccine for High Risk and VFC Vaccine for High Risk and VFC Vaccine for High Risk and VFC Vaccine for High Risk and VFC Vaccine for High Risk and VFC Zoster Vaccine
90632, 90636, 90675, 90690, 90691, 90717, 90732 thru 90734 90758 90619 thru 90621, 90630, 90651 90632
90633
90636, 90660
90682
90689
90732, 90734
90740
90756
90750
Required Modifiers SK
SK None SK, SL SL SK, SL None SK, SL SK, SL None None None
Infusion Therapy Psychiatry
P1, ZE, ZF, ZG, 22, 99 22, 99 SA, SB, U7, 99
22, 99
SA, SB, U7, 22, 99
Part 2 ? Modifiers Used with Procedure Codes
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Page updated: December 2021
Table of Codes and Modifiers (continued)
Service or Procedure Codes or Code Ranges
Gastroenterology
99 None SA, SB, UD, U7, 99
P1, ZE, ZF, ZG, 22, 99 22, 99 99 None 99 22, 99 TC, ZS, 26, 99 22, 99, TC, 26 22, 99 22, 99
SA, U7, 22, 99 22, 99 22, 99 22, 99 22, 99 None 22, 99 None 22, 99 None AP, 99 22, 99
Part 2 ? Modifiers Used with Procedure Codes
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Page updated: December 2021
Table of Codes and Modifiers (continued)
Service or Procedure Codes or Code Ranges
Ophthalmology Special Otorhinolaryngologic Special Otorhinolaryngologic Special Otorhinolaryngologic Special Otorhinolaryngologic Special Otorhinolaryngologic Special Otorhinolaryngologic Special Otorhinolaryngologic Special Otorhinolaryngologic Special Otorhinolaryngologic Special Otorhinolaryngologic Cardiovascular
J7351 92502 92504 thru 92516 92517 thru 92519 92520 thru 92534 92541 thru 92547 92551 thru 92582 92587, 92588 92589 thru 92640 92650 thru 92653 92700 92920
Cardiovascular Cardiovascular
92921 92924
Cardiovascular Cardiovascular
92925 92928
Cardiovascular Cardiovascular
92929 92933
Cardiovascular Cardiovascular
92934 92937
Required Modifiers RT, LT None
None
None
None
TC, 26
None
TC, ZS, 26
None
None
None
LM, LD, LC, RC, RI None LM, LD, LC, RC, RI None LM, LD, LC, RC, RI None LM, LD, LC, RC, RI None LM, LD, LC, RC, RI
Allowable Modifiers UD, 99 P1, ZA, ZE, ZF, ZG, 22, 99 22, 99
SA, U7, 99
22, 99
99
None
22, 99
22, 99
GT, GQ, SA, U7, 99 22, 99
53
53 22, 53, 99
22, 53, 99 53
53 22, 53, 99
22, 53, 99 22, 53, 99
Part 2 ? Modifiers Used with Procedure Codes
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