Medicare Part A Modifiers
This document was uploaded by user and they confirmed that they have the permission to share it. If you are author or own the copyright of this book, please report to us by using this DMCA report form. Report DMCA
Overview
Download & View Medicare Part A Modifiers as PDF for free.
More details
- Words: 623
- Pages: 3
TrailBlazer Health Enterprises, LLC EDUCATION MAKES THE DIFFERENCE
Medicare Part A Modifiers Modifier
Description
25
Significant, separately identifiable evaluation and management service by the same 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 59
Staged or related procedure or service by the same physician during the postoperative period 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 Erythropoiesis Stimulating Agent (ESA) administered to treat anemia due to anticancer chemotherapy ESA administered to treat anemia due to anti-cancer radiotherapy
EA EB EC ET E1
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) edit bypass for hospital Emergency Room (ER) services spanning multiple service dates Upper left, eyelid
Published February 2008
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 GH
Performance and payment of a screening mammogram and diagnostic mammogram on the same patient, same day 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
GZ
Dosage of epoetin or darbepoetin has been reduced 25 percent of preceding month’s dosage Item or service statutorily excluded or does not meet the definition of any Medicare benefit 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)
GY
Page 2 of 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
RC
Routine clinical service provided in a clinical research study that is in an approved clinical research study 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
Q1
Page 3 of 3
Medicare Part A Modifiers Modifier
Description
25
Significant, separately identifiable evaluation and management service by the same 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 59
Staged or related procedure or service by the same physician during the postoperative period 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 Erythropoiesis Stimulating Agent (ESA) administered to treat anemia due to anticancer chemotherapy ESA administered to treat anemia due to anti-cancer radiotherapy
EA EB EC ET E1
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) edit bypass for hospital Emergency Room (ER) services spanning multiple service dates Upper left, eyelid
Published February 2008
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 GH
Performance and payment of a screening mammogram and diagnostic mammogram on the same patient, same day 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
GZ
Dosage of epoetin or darbepoetin has been reduced 25 percent of preceding month’s dosage Item or service statutorily excluded or does not meet the definition of any Medicare benefit 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)
GY
Page 2 of 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
RC
Routine clinical service provided in a clinical research study that is in an approved clinical research study 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
Q1
Page 3 of 3
Related Documents
Medicare Part A Modifiers
October 2019 12
Modifiers
October 2019 25
Modifiers
November 2019 20
Medicare
July 2020 16
Modifiers 1
October 2019 22
Casting Modifiers
October 2019 23More Documents from ""
Cms 1450 (ub-04)
October 2019 24
Proper Use Of Modifier 59
October 2019 20
Cms 1500 Instructions
October 2019 33
Snf Consolidated Billing - Q & A
December 2019 29
Cms 1500
October 2019 40