Medicare Part A Modifiers
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This document lists and describes Medicare modifiers used to provide additional information about evaluation and management services, procedures, visits, and other services. There are over 70 modifiers explained, which identify things like bilateral procedures, discontinued or repeated services, visits by multiple physicians, or services provided to specific body parts or areas. The modifiers assist Medicare in processing and paying claims accurately based on the details provided.
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Medicare Part A Modifiers
- 1. TrailBlazer Health Enterprises, LLC EDUCATION MAKES THE DIFFERENCE Medicare Part A Modifiers Modifier Description Significant, separately identifiable evaluation and management service by the same 25 physician on the same day of the procedure or other service 27 Multiple outpatient hospital evaluation/management encounters on the same day 50 Bilateral procedure 52 Reduced services 58 Staged or related procedure or service by the same physician during the postoperative period 59 Distinct procedural service 73 Discontinued outpatient procedure prior to the administration of anesthesia 74 Discontinued outpatient procedure after the administration of anesthesia 76 Repeat procedure by same physician on same day 77 Repeat procedure by another physician on same day 78 Return to the operating room for a related procedure during the postoperative period 79 Unrelated procedure or service by the same physician during the postoperative period 91 Repeat clinical diagnostic laboratory test Level II (HCPCS) Modifiers BL Purchased blood and blood products CA Procedure payable only in the inpatient setting when performed emergently on an outpatient who expires prior to admission EA Erythropoiesis Stimulating Agent (ESA) administered to treat anemia due to anti- cancer chemotherapy EB ESA administered to treat anemia due to anti-cancer radiotherapy EC ESA administered to treat anemia not due to anti-cancer chemotherapy or anti-cancer radiotherapy Skilled Nursing Facility (SNF) Consolidated Billing (CB) Common Working File (CWF) ET edit bypass for hospital Emergency Room (ER) services spanning multiple service dates E1 Upper left, eyelid Published February 2008
- 2. Modifier Description E2 Lower left, eyelid E3 Upper right, eyelid E4 Lower right, eyelid FA Left hand, thumb FB Item provided without cost or full credit received for replaced device FC Partial credit received for replaced device 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 GA Waiver of liability statement on file GG Performance and payment of a screening mammogram and diagnostic mammogram on the same patient, same day GH Diagnostic mammogram converted from screening mammogram on the same day GN Service delivered under an outpatient speech-language pathology plan of care GO Service delivered under an outpatient occupational therapy plan of care GP Service delivered under an outpatient physical therapy plan of care GS Dosage of epoetin or darbepoetin has been reduced 25 percent of preceding month’s dosage GY Item or service statutorily excluded or does not meet the definition of any Medicare benefit GZ Item or service expected to be denied as not reasonable and necessary KX Therapy services that exceed the therapy cap LC Left circumflex, coronary artery (hospitals use with codes 92980-92984, 92995, 92996) Page 2 of 3
- 3. Modifier Description LD Left anterior descending coronary artery (hospitals use with codes 92980-92984, 92995, 92996) LT Left side (used to identify procedures performed on the left side of the body) QM Ambulance service provided under arrangement by a provider of services QN Ambulance service provided directly by a provider of services Q0 (zero) 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 RC Right coronary artery (hospitals use with codes 92980-92984, 92995, 92996) RT Right side (used to identify procedures performed on the right side of the body) TA Left foot, great toe 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 Page 3 of 3