ࡱ> a bjbj AbAb B B BBB`|B=%%(((*** = = = = = = =$Z?B/=***@**/=((D=666*(( =6* =66a66(sQ0h/y6<Z=0=6Ch/C6C6l**6*****/=/=3***=****C*********B B : Below is a list of approved modifier codes for use in billing Medi-Cal. Modifiers not listed in this section are unacceptable for billing Medi-Cal. Modifier Overview Some modifier information in this section is taken from the CPT code book (Current Procedural Terminology code book) and HCPCS code book (Healthcare Common Procedure Coding System, Level II). Discontinued Modifiers Medicaid programs have traditionally tailored modifiers for their states needs. These interim (or local) modifiers are being phased out under HIPAA requirements. Refer to the list of discontinued and invalid modifiers at the end of this section. National Correct Medi-Cal claims are subject to a set of claims processing edits that Coding Initiative are federally mandated. The edits, controlled by the Centers for Medicare & Medicaid Services (CMS), are part of the National Correct Coding Initiative (NCCI). Modifiers relevant to the NCCI edit methodology are designated NCCI associated in the following modifier list. See the Correct Coding Initiative: National section for how NCCI affects reimbursement. Note: NCCI does not allow more than one NCCI-associated modifier on a line for Treatment Authorization Requests (TARs), CMS-1500 claims and UB-04 claims. TARs and claims containing two or more NCCI-associated modifiers on the same line will be denied. In addition, placement of modifiers on the claim is important. An NCCI-associated modifier should not appear in the first modifier position (next to the procedure code) unless it is the only modifier on that claim line. Approved ModifierNational Modifier DescriptionProgram-Specific Use of the Modifier and Special Considerations22*Increased procedural servicesMay be used with computed tomography (CT) codes when additional slices are required or a more detailed evaluation is necessary. Used by Local Educational Agency (LEA) to denote an additional 15-minute service increment rendered beyond the required initial service time. See Local Educational Agency (LEA) in the appropriate Part 2 manual for more information. Surgical: May be billed when procedures involve significantly increased operative complexity and/or time in a significantly altered surgical field resulting from the effects of prior surgery, marked scarring, adhesions, inflammation, or distorted anatomy, irradiation, infection, very low weight (for example, neonates and small infants less than 10 kg) and/or trauma (as documented in a recipients medical record). Justification is required on the claim. Anesthesia: Prone position, base units less than or equal to three units.24* NCCI associatedUnrelated E&M service by the same physician or other qualified health care professional during a postoperative period25* NCCI associatedSignificant, separately identifiable E&M service by the same physician or other qualified health care professional on the same day of the procedure or other service26*Professional component Approved ModifierNational Modifier DescriptionProgram-Specific Use of the Modifier and Special Considerations27* NCCI associatedIncreased procedural services33*Preventive serviceClaims billed using modifier 33 are not subject to specific ICD-10-CM inclusion and/or exclusion criteria. Use of modifier 33 indicates the service was provided in accordance with a U.S. Preventive Services Task Force A or B recommendation.47*Anesthesia by surgeonDo not use as a modifier for anesthesia codes.50*Bilateral procedure51*Multiple procedures52*Reduced servicesSurgical: For use with surgery codes 66820 66821, 66830, 66840, 66850, 66920, 66930, 66940 and 66982 66985. Requires By Report documentation. Used by LEA to denote an annual re-assessment. See Local Educational Agency (LEA) in the appropriate Part 2 manual for more information. LEA does not require By Report documentation.53*Discontinued procedureRequires By Report documentation.54*Surgical care only55*Postoperative management only57 Decision for surgery (major surgery only, day before or day of procedure)58* NCCI associatedStaged or related procedure or service by the same physician during the postoperative periodMay be used with codes 15002 15429 and 52601 to address subsequent part(s) of a staged procedure. Approved ModifierNational Modifier DescriptionProgram-Specific Use of the Modifier and Special Considerations59* NCCI associatedDistinct procedural serviceUsed primarily with codes 36818 36819 and 76816. Also used with other codes, as appropriate, for NCCI purposes.62*Two surgeons66*Surgical team73Discontinued outpatient hospital/ambulatory surgery center (ASC) procedure prior to the administration of anesthesia (to be reported by hospital outpatient department or surgical clinic, only)To be reported by hospital outpatient department or surgical clinic only. Requires By Report documentation.74Discontinued outpatient hospital/ambulatory surgery center (ASC) procedure after administration of anesthesiaTo be reported by hospital outpatient department or surgical clinic only. Requires By Report documentation.76*Repeat procedure or service by same physician77*Repeat procedure by another physician78* NCCI associatedUnplanned return to the operating/procedure room by the same physician following initial procedure for a related procedure during the postoperative period Approved ModifierNational Modifier DescriptionProgram-Specific Use of the Modifier and Special Considerations79* NCCI associatedUnrelated procedure or service by the same physician during the postoperative period80*Assistant surgeon90*Reference (outside) laboratoryOnly specified providers may use this modifier.91* NCCI associatedRepeat clinical diagnostic laboratory test95Synchronous telemedicine service rendered via a real-time interactive audio and video telecommunications system99*Multiple modifiersUsed when two or more modifiers are necessary to completely delineate a service; the multiple modifiers used must be explained in the Remarks field (Box 80)/Additional Claim Information field (Box 19) of the claim. Do not bill 99 when billing split-billable claims without a modifier (professional and technical service component) or with modifier 26 (professional component) and TC (technical component). The claim will be denied. Also used in special circumstances as specified by the Department of Health Care Services (DHCS). For an example, refer to the Surgery Billing Examples: UB-04 or Surgery Billing Examples: CMS-1500 sections in the appropriate Part 2 manual. Approved ModifierNational Modifier DescriptionProgram-Specific Use of the Modifier and Special ConsiderationsAAAnesthesia performed by an anesthesiologistAGPrimary physicianSurgical: Used to denote a primary surgeon. In the case of multiple primary surgeons, two or more surgeons can use modifier AG for the same patient on the same date of service if the procedures are performed independently and in different specialty areas. This does not include surgical teams or surgeons performing a single procedure requiring different skills. An explanation of the clinical situation and operative reports by all surgeons involved must be included with the claim. Used by LEA to denote licensed physicians/psychiatrists. See Local Educational Agency (LEA) in the appropriate Part 2 manual for more information.AHClinical psychologistUsed by LEA to denote licensed psychologists, licensed educational psychologists and credentialed school psychologists. See Local Educational Agency (LEA) in the appropriate Part 2 manual for more information.AIPrincipal physician of recordAllowable for all procedure codes.AJClinical social workerUsed by LEA to denote licensed clinical social workers and credentialed school social workers. See Local Educational Agency (LEA) in the appropriate Part 2 manual for more information. Approved ModifierNational Modifier DescriptionProgram-Specific Use of the Modifier and Special ConsiderationsAPDetermination of refractive state was not performed in the course of diagnostic ophthalmological examinationUse only for ophthalmology.ASPhysician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgeryCertified nurse midwives (CNM) may be reimbursed as an assistant at surgery during cesarean section deliveries performed by a licensed physician and surgeon.AYItem or service furnished to an ESRD patient that is not for the treatment of ESRDAZPhysician providing a service in a dental health profession shortage area for the purpose of an electronic health record incentive paymentCSItem of service related, in whole or in part, to an illness, injury, or condition that was caused by or exacerbated by the effects, direct or indirect, of the 2010 oil spill in the Gulf of Mexico, including but not limited to subsequent clean-up activitiesDAOral health assessment by a licensed health professional other than a dentistDSAmbulance service origin code D (diagnostic or therapeutic site other than P or H when these are used as origin codes) with ambulance service destination code S (scene of accident or acute event)Medical transport dry run. When billed with modifier QN, modifier DS must be in the first modifier position. Approved ModifierNational Modifier DescriptionProgram-Specific Use of the Modifier and Special ConsiderationsE1 NCCI associatedUpper left, eyelidUse modifier SC with CPT code 68761 (closure of lacrimal punctum; by thermocauterization, ligation, or laser surgery; by plug, each) to indicate use of temporary collagen punctal plugs. Modifiers E1 thru E4 are used in connection with permanent silicone punctal plugs and procedures on the eyelids.E2 NCCI associatedLower left, eyelidSame as aboveE3 NCCI associatedUpper right, eyelidSame as aboveE4 NCCI associatedLower right, eyelidSame as aboveEPService provided as part of a Medicaid early and periodic screening diagnostic and treatment (EPSDT).ETEmergency servicesF1 NCCI associatedLeft hand, second digitF2 NCCI associatedLeft hand, third digitF3 NCCI associatedLeft hand, fourth digitF4 NCCI associatedLeft hand, fifth digitF5 NCCI associatedRight hand, thumbF6 NCCI associatedRight hand, second digitF7 NCCI associatedRight hand, third digit Approved ModifierNational Modifier DescriptionProgram-Specific Use of the Modifier and Special ConsiderationsF8 NCCI associatedRight hand, fourth digitF9 NCCI associatedRight hand, fifth digitFA NCCI associatedLeft hand, thumbFPFamily planning servicesAdd modifier to HCPCS and CPT codes as appropriate: Z1032 Z1038 + FP Z6200 Z6500 + FP 59400 + FP 59510 + FP 59610 + FP 59618 + FP 99201 99215 + FP 99241 99245 + FP 99281 99285 + FP 99341 99353 + FP 99384 + FP 99394 + FPGCPhysician services provided by a resident and teaching physicianAdd modifier to CPT codes 99201 99499 (Evaluation and Management Services) as appropriate.GNService delivered under an outpatient speech-language pathology plan of careUsed by LEA to denote licensed speech-language pathologists and speech-language pathologists. See Local Educational Agency (LEA) in the appropriate Part 2 manual for more information. Approved ModifierNational Modifier DescriptionProgram-Specific Use of the Modifier and Special ConsiderationsGOService delivered under an outpatient occupational therapy plan of careUsed by LEA to denote registered occupational therapists. See Local Educational Agency (LEA) in the appropriate Part 2 manual for more information.GPService delivered under an outpatient physical therapy plan of careUsed by LEA to denote licensed physical therapists. See Local Educational Agency (LEA) in the appropriate Part 2 manual for more information.GQVia asynchronous telecommunications systemUsed to denote store-and-forward telecommunications system.GTService rendered via interactive audio and video telecommunications systemsUsed to denote real-time telecommunications system.GUWaiver of liability statement issued as required by payer policy, routine noticeGXNotice of liability issued, voluntary under payer policyGYItem or service statutorily excluded; does not meet the definition of any Medicare benefit or for non-Medicare insurers, is not a contract benefitUsed to denote that the Early and Periodic Screening, Diagnostic and Treatment (EPSDT) recipient with full-scope Medi-Cal has started a physician-ordered course of treatment before reaching 21 years of age and the recipient is to complete the course of the prescribed treatment; OR the recipient started a physician-ordered course of treatment before July 1, 2009, and required additional time to complete treatment after this date. GY is to be used ONLY for services exempted from the optional benefits exclusion policy. Use of GY only applies to medical/surgical care required for the treatment and the resolution of the acute episode. Approved ModifierNational Modifier DescriptionProgram-Specific Use of the Modifier and Special ConsiderationsHAChild/adolescent programUsed by pediatric subacute facility to denote that the patient is a child.HBAdult program, nongeriatricUsed by adult subacute facility to denote that the patient is an adult.HDPregnant/parenting womens programUsed when billing for either a positive or negative depression screening for pregnant or postpartum recipients.HMLess than bachelor degree levelUsed to denote that the rendering provider is certified as a Sign Language Interpreter.HNAmbulance service origin code H (hospital) with ambulance service destination code N (skilled nursing facility)Ambulance modifier H may be used in conjunction with modifier N (H+N) to indicate transportation from an acute care hospital to a skilled nursing facility. When billed with modifier QN, modifier HN must be in the first modifier position.HOMasters degree levelUsed by LEA to denote program specialists. See Local Educational Agency (LEA) in the appropriate Part 2 manual for more information.HTMulti-disciplinary teamUsed by California Community Transition (CCT) Demonstration providers to denote CCT services.J4DMEPOS item subject to DMEPOS competitive bidding program that is furnished by a hospital upon dischargeAllowable but not required for all DME codes.KCReplacement of special power wheelchair interfaceKXRequirements specified in the medical policy have been metSpecific required documentation on file. Used by Diabetes Prevention Program (DPP) organizations to indicate DPP services were rendered through video-conferencing, online, distance learning or other virtual tool. Approved ModifierNational Modifier DescriptionProgram-Specific Use of the Modifier and Special ConsiderationsLC NCCI associatedLeft circumflex coronary arteryLD NCCI associatedLeft anterior descending coronary arteryLM Left main coronary arteryLT NCCI associatedLeft side (used to identify procedures performed on the left side of the body)NBNebulizer system, any type, FDA-cleared for use with specific drugNUNew equipment Used to denote purchase of new equipment.P1*A normal, healthy patientUsed to denote anesthesia services provided to a normal, uncomplicated patient.P3*A patient with severe systemic diseaseUsed to denote anesthesia services provided to a patient with severe systemic disease.P4*A patient with severe systemic disease that is a constant threat to lifeUsed to denote anesthesia services provided to a patient with severe systemic disease that is a constant threat to life.P5*A moribund patient who is not expected to survive without the operationUsed to denote anesthesia services provided to a moribund patient who is not expected to survive without the operation. Approved ModifierNational Modifier DescriptionProgram-Specific Use of the Modifier and Special ConsiderationsPASurgery, wrong body partAllowable for all procedure codes.PBSurgery, wrong patientAllowable for all procedure codes.PCWrong surgery on patientAllowable for all procedure codes.PIPositron emission tomography (PET) or PET/computed tomography (CT) to inform initial treatment strategy of tumorsAllowable but not required for all radiology procedure codes.PSPET or PET/CT to inform the subsequent treatment strategy of cancerous tumorsAllowable but not required for all radiology procedure codes.PTColorectal cancer screening test; converted to diagnostic test or other procedureQAPrescribed amounts of stationary oxygen for daytime use while at rest and nighttime use differ and the average of the two amounts is less than one liter per minute (LPM)QBPrescribed amounts of stationary oxygen for daytime use while at rest and nighttime use differ and the average of the two amounts exceeds four LPM and portable oxygen is prescribedQEPrescribed amount of stationary oxygen while at rest is less than one LPMQFPrescribed amount of stationary oxygen while at rest exceeds four LPM and portable oxygen is prescribedQGPrescribed amount of stationary oxygen while at rest is greater than four LPMUse this modifier if portable oxygen is NOT prescribed.QRPrescribed amounts of stationary oxygen for daytime use while at rest and nighttime use differ and the average of the two amounts is greater than four LPMUse this modifier if portable oxygen is NOT prescribed. Approved ModifierNational Modifier DescriptionProgram-Specific: Use of the Modifier and Special ConsiderationsQKMedical direction of two, three or four concurrent anesthesia procedures involving qualified individualsNote: Modifier QK will also be used when billing for the supervision of one anesthesia procedure.QNAmbulance service furnished directly by a provider of servicesMay be used in conjunction modifier HN for medical transportation, which is the combination of ambulance service origin code H (hospital) and ambulance service destination code N (skilled nursing facility). QPDocumentation is on file showing that the laboratory test(s) was ordered individually or ordered as a CPT-recognized panel other than automated profile codes 80002 80019, G0058, G0059 and G0060Used for lab codes where documentation is on file showing that the test was ordered individually.QSMonitored anesthesia care serviceUsed by California Childrens Services (CCS) to denote monitored anesthesia care.QWCLIA waived testUsed to indicate that the provider is performing testing for the procedure with the use of a specific test kit from manufacturers identified by the Centers for Medicare & Medicaid Services (CMS).QXCRNA service: with medical direction by a physicianQYMedical direction of one certified registered nurse anesthetist (CRNA) by an anesthesiologistQZCRNA service: without medical direction by a physicianRAReplacementUsed to indicate replacement vision care frames and lenses.RBReplacement as part of a repairUsed to indicate replacement parts during repair of Durable Medical Equipment (DME), including parts of eyeglass frames. Approved ModifierNational Modifier DescriptionProgram-Specific Use of the Modifier and Special ConsiderationsRC NCCI associatedRight coronary arteryRI Ramus intermediusRRRentalUsed to indicate when DME is to be rented.RT NCCI associatedRight side (used to identify procedures performed on the right side of the body)SANurse practitioner rendering service in collaboration with a physicianSBNurse midwifeUsed when Certified Nurse Midwife service is billed by a physician, hospital outpatient department or organized outpatient clinic (not by CNM billing under his or her own provider number).SCMedically necessary service or supplySEState and/or federally funded programs/servicesSKMember of high-risk population (use only with codes for immunization)SLState-supplied vaccineUsed for Vaccines For Children (VFC) program recipients through 18 years of age. Approved ModifierNational Modifier DescriptionProgram-Specific Use of the Modifier and Special ConsiderationsT1 NCCI associatedLeft foot, second digitT2 NCCI associatedLeft foot, third digitT3 NCCI associatedLeft foot, fourth digitT4 NCCI associatedLeft foot, fifth digitT5 NCCI associatedRight foot, great toeT6 NCCI associatedRight foot, second digitT7 NCCI associatedRight foot, third digitT8 NCCI associatedRight foot, fourth digitT9 NCCI associatedRight foot, fifth digit Approved ModifierNational Modifier DescriptionProgram-Specific Use of the Modifier and Special ConsiderationsTA NCCI associatedLeft foot, great toeTCTechnical componentTDRegistered nurse (RN)TELicensed practical nurse (LPN)/Licensed vocational nurse (LVN)Used by LEA to denote licensed vocational nurses. See Local Educational Agency (LEA) in the appropriate Part 2 manual for more information. Used by Pediatric Palliative Care Waiver Program (PPCWP) to denote licensed vocational nurses providing services to children receiving palliative care services.TGComplex/high tech level of careTHObstetrical treatment/services, prenatal or postpartumUsed to denote that the service rendered is ONLY for pregnancy-related services and services for the treatment of other conditions that might complicate the pregnancy. Modifier TH can be used for up to 60 days after termination of pregnancy. TH is to be used ONLY for services exempted from the optional benefits exclusion policy.TLEarly intervention/Individualized Family Services Plan (IFSP)Used by LEA to denote that service is part of IFSP. See Local Educational Agency (LEA) in the appropriate Part 2 manual for more information.TMIndividualized Education Plan (IEP)Used by LEA to denote that service is part of individualized education plan. See Local Educational Agency (LEA) in the appropriate Part 2 manual for more information. Approved ModifierNational Modifier DescriptionProgram-Specific Use of the Modifier and Special ConsiderationsTSFollow-up serviceUsed by LEA to denote an amended re-assessment. See Local Educational Agency (LEA) in the appropriate Part 2 manual for more information.TTIndividualized service provided to more than one patient in same settingUsed by Home and Community-Based Services (HCBS) Waiver Program to denote services provided to two HCBS Nursing Facility/Acute Hospital (NF/AH) Waiver recipients who reside in the same residence. Also referred to as shared services.TUSpecial payment rate, overtime, (air ambulance transportation only), (emergency or non-emergency)Used by medical transportation to bill for waiting time in excess of the first 15 minutes, in one-half (1/2) hour increments.U1Medicaid level of care 1, as defined by each stateUsed by HCBS Waiver Program to denote skilled nursing services A or B level of care. Also used with HCPCS code A4269 to indicate the type of spermicide (gel, jelly, foam, cream). See the Family Planning section in the appropriate Part 2 manual or the Family PACT Policies, Procedures and Billing Instructions (PPBI) manual for details.U2Medicaid level of care 2, as defined by each stateUsed by HCBS Waiver Program to denote skilled nursing services A or B level of care. Also used with HCPCS code A4269 to indicate the type of spermicide (suppository). See the Family Planning section in the appropriate Part 2 manual or the Family PACT PPBI manual for details.U3Medicaid level of care 3, as defined by each stateUsed by HCBS Waiver Program to denote skilled nursing services A or B level of care. Also used with HCPCS code A4269 to indicate the type of spermicide (vaginal film). See the Family Planning section in the appropriate Part 2 manual or the Family PACT PPBI manual for details.U4Medicaid level of care 4, as defined by each stateAlso used with HCPCS code A4269 to indicate the type of spermicide (contraceptive sponge). See the Family Planning section in the appropriate Part 2 manual or the Family PACT PPBI manual for details. Approved ModifierNational Modifier DescriptionProgram-Specific Use of the Modifier and Special ConsiderationsU5Medicaid level of care 5, as defined by each stateUsed with HCPCS code J3490 to indicate emergency contraceptive pills (ulipristal acetate). See the Family Planning section in the appropriate Part 2 manual or the Family PACT PPBI manual for details.U6Medicaid level of care 6, as defined by each stateUsed by HCBS Waiver Program to separate California Community Transitions (CCT) services from other waiver services. Used with HCPCS code J3490 to indicate emergency contraceptive pills (levonorgestrel). See the Family Planning section in the appropriate Part 2 manual or the Family PACT PPBI manual for details. Also used by Family PACT (Planning, Access, Care and Treatment) Program with HCPCS codes 99401, 99402 and 99403 to indicate Education and Counseling (E&C) services. See the Family PACT PPBI manual for details.U7Medicaid level of care 7, as defined by each stateUsed to denote services rendered by Physician Assistant (PA).U8Medicaid level of care 8, as defined by each stateUsed with HCPCS code J3490 to indicate medroxyprogesterone acetate for contraceptive use.U9Medicaid level of care 9, as defined by each stateUsed to denote services rendered by licensed midwife (LM).UAMedicaid level of care 10, as defined by each stateUsed for surgical or non-general anesthesia related supplies and drugs, including surgical trays and plaster casting supplies, provided in conjunction with a surgical procedure code. Also used to indicate outpatient heroin detoxification services per visit, days 1 7. See the Heroin Detoxification Billing Codes section for details.UBMedicaid level of care 11, as defined by each stateUsed for surgical or general anesthesia related supplies and drugs, including surgical trays and plaster casting supplies, provided in conjunction with a surgical procedure code. Also used to indicate outpatient heroin detoxification services per visit, days 8 21. See the Heroin Detoxification Billing Codes section for details. Approved ModifierNational Modifier DescriptionProgram-Specific Use of the Modifier and Special ConsiderationsUCMedicaid level of care 12, as defined by each stateUsed to indicate outpatient heroin detoxification services once per week, days 8 21 (in lieu of UB). See the Heroin Detoxification Billing Codes section for details.UDMedicaid level of care 13, as defined by each stateUsed by Section 340B providers to denote services provided or drugs purchased under this program.UJServices provided at nightUsed by medical transportation to indicate that services were provided between 7 p.m. and 7 a.m.UNTwo patients servedUsed to indicate that two patients were served in medical transportation.UPThree patients servedUsed to indicate that three patients were served in medical transportation.UQFour patients servedUsed to indicate that four patients were served in medical transportation.URFive patients servedUsed to indicate that five patients were served in medical transportation.USSix or more patients servedUsed to indicate that six or more patients were served in medical transportation.V5Any vascular catheter (alone or with any other vascular access)Allowable for all procedure codes.V6Arteriovenous graft (or other vascular access not including a vascular catheter)Allowable for all procedure codes.V7Arteriovenous fistula only (in use with two needles)Allowable for all procedure codes.XE NCCI AssociatedSeparate encounter: a service that is distinct because it occurred during a separate encounter XP NCCI AssociatedSeparate practitioner: a service that is distinct because it was performed by a different practitioner  Approved ModifierNational Modifier DescriptionProgram-Specific Use of the Modifier and Special ConsiderationsXS NCCI AssociatedSeparate structure: a service that is distinct because it was performed on a separate organ/structure XU NCCI AssociatedUnusual non-overlapping service: the use of a service that is distinct because it does not overlap usual components of the main serviceYWNot applicable. This is an interim (local) modifier.Required professional experience (applies only to speech therapists and audiologists).ZLNot applicable. This is an interim (local) modifier.This modifier is used to certify that initial comprehensive antepartum office visit occurred within 16 weeks of the last menstrual period (LMP) (up to and including pregnancies of 16 weeks and 0/7ths days gestation only). Used with HCPCS code Z1032 only. (Reimbursed only once during pregnancy service limitation of once in nine months.) Use of this modifier adds $56.63 to reimbursement. Available only to Comprehensive Perinatal Services Program (CPSP) providers. For enrollment information, see Pregnancy: Comprehensive Perinatal Services Program (CPSP) in the appropriate Part 2 manual. Discontinued and Invalid Modifiers Below is a list of discontinued and invalid modifier codes for use in billing Medi-Cal. Modifiers listed below are no longer acceptable for billing Medi-Cal. Discontinued/ Invalid ModifierDiscontinuation DateModifier Description21September 1, 2009Prolonged evaluation and management services (see Evaluation and Management [E&M] section in the appropriate provider manual on how to bill for prolonged E&M visits).60May 1, 2009Altered surgical field. Use modifier 22.75May 1, 2009Concurrent care, services rendered by more than one physician.AFAugust 1, 2005Anesthesia complicated by total body hypothermia above 30 degrees.ANFebruary 1, 2009Physician assistant service. Replaced by HIPAA compliant modifier U7.V8October 1, 2012Infection present. Allowable for all procedure codes.V9October 1, 2012No infection present. Allowable for all procedure codes. Discontinued/ Invalid ModifierDiscontinuation DateModifier DescriptionY1November 1, 2005Rental without sales tax (hearing aids).Y2November 1, 2005Purchase or repair without sales tax (hearing aids).Y6November 1, 2005Rental with sales tax (hearing aids).Y7November 1, 2005Purchase, repair, mileage with sales tax (standard item, hearing aids).YQNovember 1, 2005Certified Nurse Midwife service (when billed by a physician, organized outpatient clinic or hospital outpatient department). Replaced by HIPAA compliant modifier SB.YRFebruary 1, 2009Certified Nurse Midwife service (multiple modifiers) (when billed by a physician, organized outpatient clinic or hospital outpatient department). Replaced by HIPAA compliant modifier 99.YSNovember 1, 2005Nurse Practitioner service. Replaced by HIPAA compliant modifier SA.YTFebruary 1, 2009Nurse Practitioner service (multiple modifiers). Replaced by HIPAA compliant modifier 99.YUFebruary 1, 2009Physician Assistant service (multiple modifiers). Replaced by HIPAA compliant modifier 99.YVJuly 1, 2001AIDS Waiver providers only. Administrative expenses when billed by Computer Media Claims (CMC). Discontinued/ Invalid ModifierDiscontinuation DateModifier DescriptionZ1Not applicable. This is an interim (local) modifier.Additional air mileage in excess of 10 percent of standard airway mileage distances. Reason for additional mileage flown must be documented on the claim or on an attachment.ZAMarch 1, 2011Anesthesia procedures complicated by unusual position or surgical field avoidance. Note: This local modifier was discontinued March 1, 2011. Use of this local modifier will result in claim denial.ZBMarch 1, 2011Anesthesia (emergency services, healthy patient). Note: This local modifier was discontinued March 1, 2011. Use of this local modifier will result in claim denial.ZCMarch 1, 2011Anesthesia complicated by extracorporeal circulation. Note: This local modifier was discontinued March 1, 2011. Use of this local modifier will result in claim denial.ZDMarch 1, 2011Emergency anesthesia (systemic disease).ZEMarch 1, 2011Nurse anesthetist service; elective anesthesia: normal, healthy patient.ZFMarch 1, 2011Anesthesia supervision.ZGMarch 1, 2011Multiple anesthesia modifiers.ZHMarch 1, 2011Nurse anesthetist service; anesthesia special circumstances: unusual position/field avoidance.ZIMarch 1, 2011Nurse anesthetist service; anesthesia special circumstances: total body hypothermia.ZJMarch 1, 2011Nurse anesthetist service; emergency anesthesia: normal, healthy patient.ZKNovember 1, 2005Primary Surgeon. Replaced by HIPAA compliant modifier AG.ZMNovember 1, 2010Supplies and drugs for surgical procedures with other than general anesthesia or no anesthesia. Replaced by HIPAA compliant modifier UA.ZNNovember 1, 2010Supplies and drugs for surgical procedures with general anesthesia. Replaced by HIPAA compliant modifier UB.ZOMarch 1, 2011Nurse anesthetist service; anesthesia special circumstances: extracorporeal circulation.     modif app  PAGE 2 modif app Modifiers: Approved List  PAGE 1 * Check the CPT Book for Guidelines in using this modifier 2 Modifiers: Approved List ___ 2011 2 Modifiers: Approved List June 2011  modif app Modifiers: Approved List  PAGE 1 * Check the CPT-4 book for guidelines. 2 Modifiers: Approved List August 2009 modif app  PAGE 2 modif app  PAGE 3 * Check the CPT Book for Guidelines in using this modifier 2 Modifiers: Approved List March 2019 * Check the CPT Book for Guidelines in using this modifier 2 Modifiers: Approved List ___ 2011 modif app  PAGE 13 modif app  PAGE 3 * Check the CPT Book for Guidelines in using this modifier NCCI associated 2 Modifiers: Approved List March 2019 modif app  PAGE 4 * Check the CPT book for guidelines in using this modifier. 2 Modifiers: Approved List March 2011 modif app  PAGE 5 * Check the CPT book for guidelines in using this modifier. 2 Modifiers: Approved List June 2017 modif app  PAGE 6 modif app 6 2 Modifiers: Approved List April 2017 2 Modifiers: Approved List April 2017 modif app 7 modif app  PAGE 7 2 Modifiers: Approved List April 2017 modif app  PAGE 8 modif app 8 2 Modifiers: Approved List August 2018 2 Modifiers: Approved List April 2017 modif app 10 modif app  PAGE 9 2 Modifiers: Approved List April 2017 2 Modifiers: Approved List April 2017 modif app  PAGE 10 modif app 10 2 Modifiers: Approved List July 2019 2 Modifiers: Approved List April 2017 modif app  PAGE 12 modif app  PAGE 11 * Check the CPT Book for Guidelines in using this modifier NCCI associated 2 Modifiers: Approved List April 2017 2 Modifiers: Approved List June 2019 modif app  PAGE 12 modif app 12 * Check the CPT Book for Guidelines in using this modifier NCCI associated 2 Modifiers: Approved List April 2017 * Check the CPT Book for Guidelines in using this modifier NCCI associated 2 Modifiers: Approved List April 2017 modif app  PAGE 14 modif app  PAGE 13 2 Modifiers: Approved List April 2017 2 Modifiers: Approved List May 2018 modif app  PAGE 14 modif app 14 2 Modifiers: Approved List April 2017 2 Modifiers: Approved List April 2017 modif app  PAGE 16 modif app  PAGE 15 2 Modifiers: Approved List April 2017 * Check the CPT Book for Guidelines in using this modifier NCCI associated 2 Modifiers: Approved List April 2017 modif app  PAGE 16 modif app 16 2 Modifiers: Approved List April 2017 2 Modifiers: Approved List April 2017 modif app  PAGE 18 modif app  PAGE 17 2 Modifiers: Approved List April 2017 2 Modifiers: Approved List May 2019 modif app  PAGE 18 modif app 18 2 Modifiers: Approved List April 2017 2 Modifiers: Approved List April 2017 modif app  PAGE 20 modif app  PAGE 19 2 Modifiers: Approved List April 2017 2 Modifiers: Approved List April 2017 modif app  PAGE 20 modif app 20 2 Modifiers: Approved List April 2017 2 Modifiers: Approved List April 2017 modif app  PAGE 22 modif app  PAGE 21 2 Modifiers: Approved List July 2015 2 Modifiers: Approved List September 2018 modif app  PAGE 22 modif app 22 2 Modifiers: Approved List September 2018 2 Modifiers: Approved List April 2017 modif app  PAGE 14 modif app  PAGE 24 modif app  PAGE 23 2 Modifiers: Approved List April 2017 2 Modifiers: Approved List September 2018 modif app  PAGE 24 modif app  PAGE 25 2 Modifiers: Approved List September 2018 2 Modifiers: Approved List December 2017      ! 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