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Informational Only Modifier Fact Sheet

The following modifiers are Informational Only and should be placed after all pricing modifiers. Modifier 99 has specific instructions on its own separate fact sheet.

AQ Services provided in a Health Professional Shortage Area (HPSA)
CB Services ordered by a dialysis facility physician as part of the ESRD beneficiary's dialysis benefit, is not part of the composite rate, and is separately reimbursable
CR Emergency health care needs of beneficiaries and providers affected by Hurricane Katrina and any future disasters
GA The provider or supplier has provided an Advance Beneficiary Notice of Noncoverage (ABN) to the patient and has a signed copy on file
GN Services delivered under an outpatient speech-language pathology plan of care
GO Services delivered under an outpatient occupational therapy plan of care
GP Services delivered under an outpatient physical therapy plan of care
GV Attending physician not employed or paid under agreement by the patient's hospice provider
GW Service not related to the hospice patient's terminal condition
GY Statutorily excluded service - If the service provided is statutorily excluded from the Medicare Program, the claim will deny whether or not the modifier is present on the claim
GZ The provider or supplier expects a medical necessity denial; however, did not provide an Advance Beneficiary Notice of Noncoverage (ABN) to the patient
Q5 Service furnished by a substitute physician under a reciprocal billing arrangement
Q6 Service furnished by a locum tenens physician
22 Increased Procedural Service requiring work substantially greater than typically required
24 Unrelated evaluation and management (E/M) service by the same physician* during a postoperative period
25 Significant, separately identifiable evaluation and management (E/M) service by the same physician* on the day of a procedure
27 Multiple Outpatient Hospital E/M Encounters on the Same Day (Not required by CMS and not to be used by physicians for reporting of multiple E/M services)
52 Reduced Service reports a partially reduced or eliminated service or procedure
57 Indicates an Evaluation and Management (E/M) service resulted in the initial decision to perform surgery either the day before a major surgery (90-day global) or the day of a major surgery
58 Indicates a staged or related procedure or service by the same physician* during the postoperative period
59 Distinct Procedural Service identifies procedures/services not normally reported together, but appropriately billable under the circumstances
63 Procedure Performed on Infants less than 4 kg
66 If a team of surgeons (more than two surgeons of different specialties) is required to perform a specific procedure, each surgeon bills for the procedure with a modifier "-66"
74 Discontinued Out-Patient Hospital/Ambulatory Surgery Center (ASC) Procedure after administration of anesthesia
76 Repeat Procedure by the Same Physician; use when it is necessary to report repeat procedures performed on the same day
77 Repeat Procedure by another physician
79 Unrelated procedure by the same physician during the postoperative period
90 Reference (Outside) Laboratory
99 Multiple Modifiers are required on one line of service

*Same physician – Medicare regulation states: "Physicians in the same group practice who are in the same specialty must bill and be paid as though they were a single physician." The same physician concept also applies when the exact same physician performs services.

Page Last Updated: Tuesday, 15-Jul-2014 09:21:18 CDT