Modifiers

Modifiers indicate a service or procedure that has been performed has been altered by some specific circumstance but not changed in its definition or code.

When selecting the appropriate modifier to be reported with your claim, please ensure that the modifier is valid for the date of service being submitted. Examples of when modifiers may be used are:

 • Identification of only a professional or technical component

 • Repeat services by the same or different provider

 • An increased, reduced or unusual service

 • Billing for components of a global surgical package

 • Identification of a specific body area

 • To designate a bilateral procedure

 • Identification of service in a clinical trial

Periodically CMS may establish new modifiers for use in addition to the following lists. Palmetto GBA will publish any new additions on the website. Please ensure you make note of any new additions that are not reflected in this material.

• Anesthesia Modifiers

• Global Surgery Modifiers

• Surgical Modifiers

• Health Professional Shortage Area (HPSA) and Physician Scarcity Area (PSA) Modifiers

• Provider Quality Reporting Initiative (PQRI) Modifiers

• Ambulance Modifiers

• Additional CPT Modifiers

• Additional HCPCS Modifiers

Anesthesia Modifiers

One of the following modifiers must be reported with anesthesia services in the fi rst modifier field to indicate who performed the anesthesia service:

HCPCS Modifier    Description 

AA                          Anesthesia services performed personally by                           anesthesiologist

AD                          Medical supervision by a physician: more than four concurrent anesthesia

QK                          Medically directed by a physician: two, three, or four concurrent                                                                   procedures.

QY                          Anesthesiologist medically directs one CRNA

QX                          CRNA service: with medical direction by a physician

QZ                          CRNA service: without medical direction by a physician 

Global Surgery Modifiers 

The following modifiers are used by physicians to indicate a billed service is not part of a global surgical package and is eligible for separate reimbursement:

CPT Modifier  :  24

Description :  Unrelated Evaluation and Management Service by the Same Physician During a Postoperative Period: The physician may need to indicate that an evaluation and management service was performed during a postoperative period for a reason(s) unrelated to the original procedure. This circumstance may be reported by adding the CPT modifier 24 to the appropriate level of E/M service.

An excision of a malignant lesion on the left arm is performed in the office on January 10, 2013. The post-operative period designated for excision CPT code 11606 is 10 days.

The patient returns to the office on January 15, 2009 and is treated for contact dermatitis. The physician should report the appropriate evaluation and management code followed by the 24 CPT modifier, e.g., 9921224 (CPT code/CPT modifier). 

In order for the evaluation and management service to be payable in the post-operative period with the 24 CPT modifier, the diagnosis code supporting the E/M service must be different from the diagnosis code reported for the previously performed surgery. 

CPT modifier 24 should not be used for the medical management of a patient by the surgeon following surgery. Medicare recognizes CPT modifier 24 only for the care following a discharge under these circumstances: 

• The care is for immunotherapy management furnished by the transplant surgeon; 

• The care is for critical care (CPT codes 99291, 99292) for a burn or trauma patient; or 

• The documentation demonstrates that the visit occurred during a subsequent hospitalization and the diagnosis supports the fact that it is unrelated to the original surgery.