1. HCPCS Level I (CPT) Modifiers
1.1. E/M
1.1.1. -24
1.1.1.1. – Unrelated E/M service by the same physician during a post-op period
1.1.2. -25
1.1.2.1. – Significant, separately identifiable E/M service on the same day as another procedure
1.1.3. -57
1.1.3.1. – Decision for surgery made during the E/M service
1.2. Surgical
1.2.1. -22
1.2.1.1. → More work than usual
1.2.2. -23a
1.2.2.1. – Unusual anesthesi
1.2.3. -47
1.2.3.1. – Anesthesia by surgeon
1.2.4. -50
1.2.4.1. → Both sides of the body (bilateral)
1.2.5. -51
1.2.5.1. – Multiple procedures
1.2.6. -52
1.2.6.1. – Reduced services
1.2.7. -53
1.2.7.1. – Discontinued procedure
1.2.8. -54
1.2.8.1. – Surgical care only
1.2.9. -55
1.2.9.1. – Postoperative care only
1.2.10. -56
1.2.10.1. – Preoperative care only
1.2.11. -58
1.2.11.1. → Staged procedure
1.2.12. -59
1.2.12.1. → Different site or service
1.2.13. -78
1.2.13.1. → Return to OR for a related issue
1.2.14. -79
1.2.14.1. → New, unrelated surgery
1.3. Professional vs. Technical (Doctor vs. Equipment)
1.3.1. -26
1.3.1.1. → Doctor’s part (reading X-ray)
1.3.2. -TC
1.3.2.1. → Machine/equipment part
1.4. Laboratory & Pathology
1.4.1. -90
1.4.1.1. – Reference (outside) laboratory
1.4.2. -91
1.4.2.1. – Repeat clinical diagnostic laboratory test
1.4.3. -92
1.4.3.1. – Alternative lab platform testing
1.5. Radiology
1.5.1. -76
1.5.1.1. – Repeat procedure by the same physician
1.5.2. -77
1.5.2.1. – Repeat procedure by another physician
1.6. Assistant Surgeon & Anesthesia
1.6.1. -80
1.6.1.1. – Assistant surgeon
1.6.2. -81
1.6.2.1. – Minimum assistant surgeon
1.6.3. -82
1.6.3.1. – Assistant surgeon (when no resident available)
1.6.4. -AA
1.6.4.1. – Anesthesia performed by anesthesiologist
1.6.5. -QK
1.6.5.1. – Medical direction of 2–4 anesthesia cases
1.6.6. -QX
1.6.6.1. – CRNA service with physician direction
1.6.7. -QZ
1.6.7.1. – CRNA service without physician direction
2. HCPCS Level II Modifiers
2.1. Durable Medical Equipment (DME)
2.1.1. NU
2.1.1.1. → New equipment
2.1.2. RR
2.1.2.1. → Rented
2.1.3. UE
2.1.3.1. → Used
2.2. Anatomical Location
2.2.1. LT
2.2.1.1. → Left side
2.2.2. RT
2.2.2.1. → Right side
2.2.3. E1-E4
2.2.3.1. → Eyelids
2.2.4. F1-F9
2.2.4.1. → Fingers
2.2.5. TA-T9
2.2.5.1. – Toes (TA: great toe, T1-T9: other toes)
2.3. Ambulance & Transport (Medicare & Transport
2.3.1. GY
2.3.1.1. → Not covered by Medicare
2.3.2. GA
2.3.2.1. → Waiver signed
2.3.3. GZ
2.3.3.1. → Expected denial ( as not reasonable/necessary)
2.3.4. QL
2.3.4.1. → Patient pronounced dead after ambulance called
2.3.5. GM
2.3.5.1. – Multiple patients on one ambulance trip
2.4. Hospice and Nursing Facility
2.4.1. GV
2.4.1.1. – Attending physician not employed by hospice
2.4.2. GW
2.4.2.1. – Service unrelated to hospic
2.5. Therapy (Used with Medicare Part B)
2.5.1. GN
2.5.1.1. – Speech-language pathology
2.5.2. GO
2.5.2.1. – Occupational therapy
2.5.3. GP
2.5.3.1. – Physical therapy
2.6. Price & Payment
2.6.1. KX
2.6.1.1. – Meets medical necessity criteria
2.6.2. SC
2.6.2.1. – Medically necessary service or supply