New Modifier List

ATTENTION PROVIDERS

With the implementation of HIPAA, all Level III modifiers had to be changed to valid Level II modifiers. The appropriate modifier must be used based on the date of service, please refer to MO HealthNet bulletins for the specific date a modifier was changed.

21	Pricing	Prolonged evaluation and management services
22	Pricing	Unusual procedural services
25	NCCI	Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service
26	Routing	Professional Component
32	Pricing	Mandated services
50	Pricing	Bilateral procedures
52	Pricing	Reduced services
54	Routing	Surgical Care Only
55	Routing	Postoperative Management Only
56	Pricing	Preoperative management only
58	NCCI	Staged or related procedure or service by the same physician during the postoperative period
59	NCCI/Pricing	Distinct procedural service
62	Pricing	Two surgeons
63	Inactive	Procedure performed on infants
66	Pricing	Surgical team
78	NCCI	Return to the operating room for a related procedure during the postoperative period
79	NCCI	Unrelated procedure or service by the same physician during the postoperative period
80	Routing	Assistant Surgeon
91	NCCI	Repeat clinical diagnostic laboratory test
99	Inactive	Multiple modifiers
AA	Routing	Anesthesia service performed personally by anesthesiologist
AF	Pricing	Specialty physician
AH	Pricing	Clinical Psychologist
AJ	Pricing	Clinical Social Worker
AM	Pricing	Physician, team member services (CSTAR)
BA	Pricing	Item furnished in conjunction with parenteral enteral nutrition (pen) services
BO	Pricing	Orally administered nutrition, not by feeding tube
CP	Inactive	Used by Health Plan for reporting purposes only - invalid code
E1	NCCI	Upper left, eyelid
E2	NCCI	Lower left, eyelid
E3	NCCI	Upper right, eyelid
E4	NCCI	Lower right, eyelid
EP	Pricing	Service provided as part of Medicaid early periodic screening, diagnosis, and treatment (EPSDT) prog
F1	NCCI	Left hand, second digit
F2	NCCI	Left hand, third digit
F3	NCCI	Left hand, fourth digit
F4	NCCI	Left hand, fifth digit
F5	NCCI	Right hand, thumb
F6	NCCI	Right hand, second digit
F7	NCCI	Right hand, third digit
F8	NCCI	Right hand, fourth digit
F9	NCCI	Right hand, fifth digit
FA	NCCI	Left hand, thumb
GE	Pricing	Primary Care Exception (99201-99203 & 99211-99213 only, residents w/o supervising physician present)
GM	Pricing	Multiple patients on one ambulance trip
GT	Pricing	Telemedicine Pilot Project only
H9	Pricing	Court-ordered
HA	Pricing	Child/Adolescent Program (TCM and CPR)
HB	Pricing	Adult program, non geriatric
HD	Pricing	Pregnant/parenting women's program
HE	Pricing	Mental health program
HH	Pricing	Ambulance trip for a discharge/transfer from one hospital to another hospital
HI	Pricing	Integrated mental health and mental retardation/developmental disabilities program
HK	Pricing	Therapeutic Day Treatment
HM	Pricing	Less than bachelor degree level
HN	Pricing	Bachelors degree level
HO	Pricing	Masters degree level
HQ	Pricing	Group setting
HT	Inactive	Transfer from one medical facility to another (ambulance)
KJ	Pricing	CPAP/BiPAP continued coverage beyond first 3 months
LC	NCCI	Left circumflex, coronary artery
LD	NCCI	Left anterior descending coronary artery
LT	NCCI/Pricing	Left side (used to identify procedures performed on the left side of the body)
NN	Pricing	Ambulance trip from physician's office to patient's residence
NU	Routing	New Equipment (required for DME service)
PR	Inactive	Ambulance trip from physician's office to patient's residence
QF	Pricing	Greater than 4 LPM and portable oxygen is prescribed
QG	Pricing	Greater than 4 LPM (liters per minute)
QK	Routing	Medical direction of 2, 3 or 4 concurrent anesthesia procedures involving qualified individuals
QP	Inactive	Crisis intervention - psychologist
QX	Routing	CRNA service; with medical direction by a physician
QZ	Routing	CRNA service; without medical direction by a physician
RC	NCCI	Right coronary artery
RP	Routing	Replacement and Repair (required for DME service)
RR	Routing	Rental (required for DME service)
RT	NCCI/Pricing	Right side (used to identify procedures performed on the right side of the body)
RX	Inactive	Ambulance trip from patient's residence w/intermediate stop at physician's office on way to hospital
SC	Pricing	Medical necessary service or supply
SE	Routing	State and/or federally funded programs/services
SG	Routing	Ambulatory Surgical Center (ASC) facility services
SL	Pricing	State supplied vaccine
ST	Pricing	Related to a trauma or injury (CSTAR)
SU	Pricing	Procedure performed in physicians office (to denote use of facility and equipment)
T1	NCCI	Left foot, second digit
T2	NCCI	Left foot, third digit
T3	NCCI	Left foot, fourth digit
T4	NCCI	Left foot, fifth digit
T5	NCCI	Right foot, great toe
T6	NCCI	Right foot, second digit
T7	NCCI	Right foot, third digit
T8	NCCI	Right foot, fourth digit
T9	NCCI	Right foot, fifth digit
TA	NCCI	Left foot, great toe
TC	Routing	Technical Component
TD	Pricing	Registered nurse
TF	Pricing	Intermediate level of care
TG	Pricing	Complex/high tech level of care
TL	Pricing	Early intervention/individualized family services plan (IFSP)
TM	Pricing	Individualized education program (IEP)
TN	Pricing	Rural/outside providers customary service area
TR	Pricing	IEP services provided by or for a school district outside the school district originating the IEP
TS	Pricing	Follow-up service
TW	Pricing	Back-up equipment
U1	Pricing	Community Support Waiver
U2	Pricing	Consumer-Directed
U3	Pricing	Residential Care Facility (RCF) Setting
U4	Pricing	AIDS Waiver
U5	Pricing	Physical Disabilities (PD) Waiver
U6	Pricing	Independent Living (IL) Waivaer
U7	Pricing	Sexual Assault Findings Examination (SAFE) and Child Abuse Resources Examination (CARE) Network Services
U8	Pricing	Service provided in home setting
U9	Pricing	Diabetes Self-Management Training Services
UA	Pricing	(Environmental) Lead Related Service
UB	Pricing	Exception Process Service
UC	Routing	EPSDT Referral for Follow-up Care (required if EPSDT referral made)
UD	Pricing	Licensed Professional Counselor
UK	Pricing	Services provided on behalf of the client to someone other than the client
W1	Inactive	Office Surgical Procedure Physician 's Office
W2	Pricing	Outpatient Podiatry
W3	Pricing	ASC Pedodontic Restoration over 150 minutes
W4	Pricing	Community Psych. Rehab. (TOS L, Prov Type 87) orHealth Department Immunizations (Prov. Type 51)
W5	Inactive	Dental Procedures
W6	Inactive	Dental Procedures
W7	Inactive	Professional Component
W8	Inactive	Technical Component
W9	Inactive	Dental Procedures
WO	Inactive	Child Abuse Resource Education (CARE) EXAM. [To be used with W1350 Sexual Abuse Findings Examination
WQ	Inactive	Individual Educational Plan (IEP)/Individual Family Service Plan (IFSP)
WR	Inactive	Continuous Ambulatory Peritoneal Dialysis (CAPD) - Home (only use with procedure code 90945)
XC	Inactive	Complete Medical Screening
XD	Inactive	Complete Medical Screening with Referral
XE	Inactive	Developmental/Mental Health Partial Screen
XF	Inactive	Developmental/Mental Health Partial Screen with Referral
XI	Inactive	Unclothed Physical and History Screening
XJ	Inactive	Unclothed Physical and History Screening with Referral
XK	Inactive	Dental Screening
XL	Inactive	Dental Screening with Referral
XM	Inactive	Vision Screening
XN	Inactive	Vision Screening with Referral
XP	Inactive	Hearing Screening
XQ	Inactive	Hearing Screening with Referral
YA	Inactive	Physician/Dental/Podiatry Injections
YB	Inactive	Physician/Dental/Podiatry Injections
YC	Inactive	Physician/Dental/Podiatry Injections
YD	Inactive	Physician/Dental/Podiatry Injections
YE	Inactive	Physician/Dental/Podiatry Injections
YF	Inactive	Psychiatric Nurse Services
YG	Inactive	Early Periodic Screening, Diagnosis Test (EPSDT/Pediatric Services)
YH	Inactive	Advanced personal care for AIDS - State Plan
Z1	Inactive	HIV test/post-test counseling
Z2	Inactive	STD test/post-test counseling
Z3	Inactive	TB test/post-test counseling
ZO	Inactive	Ambulance out of locale
ZZ	Inactive	Third opinion