Modifiers to be used for Part A
| Program | Category | Modifier Code | Description |
| PART – A | E/M | 25 | Significant, separately identifiable Evaluation and Management (E/M) service by the same physician on the same day of the procedure or other service. |
| PART – A | Method II CAH | 26 | Professional component |
| PART – A | E/M | 27 | Multiple outpatient hospital Evaluation and Management (E/M) encounters on the same date. |
| PART – A | Anatomical | 50 | Bilateral procedure |
| PART – A | Radiological | 52 | Reduced service |
| PART – A | Surgical | 58 | Staged or related procedure or service by the same physician during the postoperative period on the same day. |
| PART – A | Anatomical | 59 | Distinct procedural service |
| PART – A | Method II CAH | 62 | Two surgeons |
| PART – A | Outpatient hospital | 73 | Discontinued outpatient procedure prior to the administration of anesthesia. |
| PART – A | Outpatient hospital | 74 | Discontinued outpatient procedure after administration of anesthesia. |
| PART – A | Outpatient hospital | 76 | Repeat procedure or service by the same physician. |
| PART – A | Outpatient hospital | 77 | Repeat procedure by another physician. |
| PART – A | Outpatient hospital | 78 | Unplanned return to the operating/procedure room by the same physician following initial procedure for a related procedure during the postoperative period. |
| PART – A | Outpatient hospital | 79 | Unrelated procedure or service by the same physician during the postoperative period. |
| PART – A | Method II CAH | 80 | Assistant surgeon |
| PART – A | Method II CAH | 81 | Minimum assistant surgeon |
| PART – A | Method II CAH | 82 | When qualified resident surgeon not available. |
| PART – A | Laboratory | 91 | Repeat clinical diagnostic laboratory test |
| PART – A | Method II CAH | AA | Anesthesia services performed personally by anesthesiologist. |
| PART – A | Method II CAH | AE | Registered dietitian |
| PART – A | Method II CAH | AH | Clinical psychologist |
| PART – A | Method II CAH | AI | Principal physician of record. |
| PART – A | Method II CAH | AK | Non-participating physician |
| PART – A | Method II CAH | AQ | Physician providing a service in an unlisted HPSA. |
| PART – A | Method II CAH | AS | PA, NP or CNS services for assistant at surgery. |
| PART – A | DMEPOS | AU | Item furnished in conjunction with a urological, ostomy or tracheostomy supply. |
| PART – A | DMEPOS | AV | Item furnished in conjunction with a prosthetic device, prosthetic or orthotic. |
| PART – A | DMEPOS | AW | Item furnished in conjunction with a surgical dressing. |
| PART – A | Outpatient Hospital | AY | Item or service furnished to an End Stage Renal Disease (ESRD) patient that is not for the treatment of ESRD. |
| PART – A | Blood | BL | Special acquisition of blood and blood products. |
| PART – A | Outpatient hospital | CA | Procedure payable only in the inpatient setting when performed emergently on an outpatient who expires prior to admission. |
| PART – A | Outpatient hospital | CB | Service ordered by a renal dialysis facility physician as part of the ESRD beneficiary’s dialysis benefit, is not part of the composite rate, and is separately reimbursable. |
| PART – A | ESRD | CD | AMCC test has been ordered by an ESRD facility or MCP physician that is part of the composite rate and is not separately billable. |
| PART – A | ESRD | CE | AMCC test has been ordered by an ESRD facility or MCP physician that is a composite rate test but is beyond the normal frequency covered under the rate and is separately reimbursable based on medical necessity. |
| PART – A | ESRD | CF | AMCC test has been ordered by an ESRD facility or MCP physician that is not part of the composite rate and is separately billable. |
| PART – A | Catastrophe/disaster | CR | Catastrophe/disaster–related |
| PART – A | Ambulance | D | Diagnostic or therapeutic site/freestanding facility (i.e., radiation therapy center) other than a physician’s office or hospital. |
| PART – A | Ambulance | E | Residential/domiciliary/custodial facility (i.e., non-skilled facility). |
| PART – A | Anatomical | E1 | Upper left, eyelid |
| PART – A | Anatomical | E2 | Lower left, eyelid |
| PART – A | Anatomical | E3 | Upper right, eyelid |
| PART – A | Anatomical | E4 | Lower right, eyelid |
| PART – A | Non-ESRD ESA | EA | Erythropoiesis Stimulating Agent (ESA) administered to treat anemia due to anti-cancer chemotherapy. |
| PART – A | Non-ESRD ESA | EB | Erythropoiesis Stimulating Agent (ESA) administered to treat anemia due to anti-cancer radiotherapy. |
| PART – A | Non-ESRD ESA | EC | Erythropoiesis Stimulating Agent (ESA) administered to treat anemia not due to anti-cancer chemotherapy or anti-cancer radiotherapy. |
| PART – A | ESRD | ED | Hematocrit level has exceeded 39 percent (or hemoglobin level has exceeded 13.0 g/dL) for three or more consecutive billing cycles immediately prior to and including the current cycle. |
| PART – A | ESRD | EE | Hematocrit level has exceeded 39 percent (or hemoglobin level has not exceeded 13.0 g/dL) for less than three consecutive billing cycles immediately prior to and including the current cycle. |
| PART – A | ESRD | EM | Emergency reserve supply (for ESRD benefit only). |
| PART – A | Outpatient hospital | ET | Emergency services |
| PART – A | Non-covered charges | EY | No physician or other licensed health care provider order on file for this item or service. |
| PART – A | Anatomical | F1 | Left hand, second digit |
| PART – A | Anatomical | F2 | Left hand, third digit |
| PART – A | Anatomical | F3 | Left hand, fourth digit |
| PART – A | Anatomical | F4 | Left hand, fifth digit |
| PART – A | Anatomical | F5 | Right hand, thumb |
| PART – A | Anatomical | F6 | Right hand, second digit |
| PART – A | Anatomical | F7 | Right hand, third digit |
| PART – A | Anatomical | F8 | Right hand, fourth digit |
| PART – A | Anatomical | F9 | Right hand, fifth digit |
| PART – A | Anatomical | FA | Left hand, thumb |
| PART – A | Credited device | FB | Item provided without cost or credit received for a replacement device (e.g., covered under warranty, replaced due to defect, free samples, etc.). |
| PART – A | Credited device | FC | Partial credit received for replaced device. |
| PART – A | Ambulance | G | Hospital-based dialysis facility (hospital or hospital-related). |
| PART – A | ESRD | G1 | Most recent URR reading of less than 60 percent. |
| PART – A | ESRD | G2 | Most recent URR reading of 60-64.9 percent. |
| PART – A | ESRD | G3 | Most recent URR reading of 65-69.9 percent. |
| PART – A | ESRD | G4 | Most recent URR reading of 70-74.9 percent. |
| PART – A | ESRD | G5 | Most recent URR reading of 75 percent or greater. |
| PART – A | ESRD | G6 | ESRD patient for whom less than seven dialysis sessions have been provided in a month. |
| PART – A | Non-covered services | GA | Waiver of liability statement issued, as required by payer policy. |
| PART – A | Method II CAH | GC | Service performed in part by a resident under the direction of a teaching physician. |
| PART – A | Method II CAH | GF | Non-physician services in a Critical Access Hospital (CAH). |
| PART – A | Outpatient hospital | GG | Performance and payment of a screening mammography and diagnostic mammography on same patient, same day. |
| PART – A | Therapy | GN | Services delivered under an outpatient Speech-Language Pathology (SLP) plan of care. |
| PART – A | Therapy | GO | Services delivered under an outpatient Occupational Therapy (OT) plan of care. |
| PART – A | Therapy | GP | Services delivered under an outpatient Physical Therapy (PT) plan of care. |
| PART – A | Method II CAH | GQ | Via asynchronous telecommunications system. |
| PART – A | ESRD | GS | Dosage of EPO or DPO has been reduced and maintained in response to hematocrit or hemoglobin level. |
| PART – A | Method II CAH | GT | Via interactive audio and video telecommunications system. |
| PART – A | Non-covered services | GX | Notice of liability issued, voluntary under payer policy. |
| PART – A | Non-covered services | GY | Item or service statutorily excluded or does not meet the definition of any Medicare benefit. |
| PART – A | Non-covered services | GZ | Item or service expected to be denied as not reasonable or necessary. |
| PART – A | Ambulance | H | Hospital (i.e., inpatient or outpatient). |
| PART – A | Ambulance | I | Site of transfer (e.g., airport or helicopter pad) between modes of ambulance transport. |
| PART – A | Ambulance | J | Non-hospital-based dialysis facility |
| PART – A | ESRD | JA | Administered intravenously. |
| PART – A | ESRD | JB | Administered subcutaneously. |
| PART – A | ESRD | JW | Drug amount discarded/not administered to any patient. |
| PART – A | Drugs and biologicals | JW | Drug amount discarded/not administered to any patient. |
| PART – A | DMEPOS | KM | Replacement of facial prosthesis including new impression/moulage. |
| PART – A | DMEPOS | KN | Replacement of facial prosthesis using previous master model. |
| PART – A | Therapy | KX | Requirements specified in the medical policy have been met. |
| PART – A | Anatomical | LC | Left circumflex coronary artery |
| PART – A | Anatomical | LD | Left anterior descending coronary artery |
| PART – A | Anatomical | LT | Left side |
| PART – A | Ambulance | N | Skilled Nursing Facility (SNF) |
| PART – A | Ambulance | P | Physician’s office (includes HMO and non-hospital facility). |
| PART – A | Surgical | PA | Surgery wrong body part |
| PART – A | Surgical | PB | Surgery wrong patient |
| PART – A | Surgical | PC | Wrong surgery on patient |
| PART – A | PET | PI | Positron Emission Tomography (PET) or PET/Computed Tomography (CT) to inform the initial treatment strategy of tumors that are biopsy-proven or strongly suspected of being cancerous based on other diagnostic testing. |
| PART – A | PET | PS | Positron Emission Tomography (PET) or PET/Computed Tomography (CT) to inform the subsequent treatment strategy of cancerous tumors when the beneficiary’s treating physician determines that the PET study is needed to inform subsequent anti-tumor strategy. |
| PART – A | Diagnostic | PT | Colorectal cancer screening test; converted to diagnostic test or other procedure. |
| PART – A | Clinical trials | Q0 | Investigational clinical service provided in a clinical research study that is in an approved clinical research study. |
| PART – A | Clinical trials | Q1 | Routine clinical service provided in a clinical research study that is in an approved clinical research study. |
| PART – A | Prison/custody | 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). |
| PART – A | Method II CAH | QK | Medical direction of two, three or four concurrent anesthesia procedures involving qualified individuals. |
| PART – A | Ambulance | QL | Patient pronounced dead after ambulance called. |
| PART – A | Ambulance | QM | Ambulance service provided under arrangement by a provider of services. |
| PART – A | Ambulance | QN | Ambulance service furnished directly by a provider of services. |
| PART – A | Method II CAH | QY | Medical direction of one CRNA by an anesthesiologist. |
| PART – A | Method II CAH | QZ | CRNA service without medical direction by a physician. |
| PART – A | Ambulance | R | Residence (patient’s home or any residence). |
| PART – A | DMEPOS | RA | Replacement of a Durable Medical Equipment (DME), orthotic or prosthetic item. |
| PART – A | DMEPOS | RB | Replacement of a part of a Durable Medical Equipment (DME), orthotic or prosthetic item furnished as part of a repair. |
| PART – A | Anatomical | RC | Right coronary artery |
| PART – A | Anatomical | RT | Right side |
| PART – A | Ambulance | S | Scene of accident or acute event. |
| PART – A | Method II CAH | SB | Nurse midwife |
| PART – A | Anatomical | T1 | Left foot, second digit |
| PART – A | Anatomical | T2 | Left foot, third digit |
| PART – A | Anatomical | T3 | Left foot, fourth digit |
| PART – A | Anatomical | T4 | Left foot, fifth digit |
| PART – A | Anatomical | T5 | Right foot, great toe |
| PART – A | Anatomical | T6 | Right foot, second digit |
| PART – A | Anatomical | T7 | Right foot, third digit |
| PART – A | Anatomical | T8 | Right foot, fourth digit |
| PART – A | Anatomical | T9 | Right foot, fifth digit |
| PART – A | Anatomical | TA | Left foot, great toe |
| PART – A | Method II CAH | TC | Technical component |
| PART – A | Non-covered services | TS | Follow-up service |
| PART – A | ESRD | V5 | Any Vascular Catheter (alone or with any other vascular access) |
| PART – A | ESRD | V6 | Arteriovenous Graft (or other vascular access not including a vascular catheter) |
| PART – A | ESRD | V7 | Arteriovenous Fistula Only (in use with two needles) |
| PART – A | ESRD | V8 | Infection present |
| PART – A | ESRD | V9 | No infection present |
| PART – A | Ambulance | X | Intermediate stop at physician’s office en route to the hospital (destination code only). |
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