Medical Billing Modifiers: HCPCS and CPT Modifier Lookup
Look up any HCPCS Level II modifier from CMS’s current file, read plain-English guides to common CPT modifiers, and compare the modifiers that are easy to mix up, such as 25 and 59, 59 and XS, or GA, GY and GZ. Every entry links to the CMS document behind it.
Common CPT Modifiers, Explained
CPT modifiers are two-digit codes that belong to the American Medical Association’s CPT code set. CureAdvantage does not reproduce the AMA’s descriptors. The 23 guides below are our own summaries of what each modifier is used to communicate, with a link to the CMS document that discusses it.
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Modifier 22
Unusually complex procedure
Tells the payer that a procedure took substantially more work than the code normally represents, for example because of unusual difficulty, time or risk. It does not change the code; it asks the payer to consider the extra work.
Check: Does the operative or procedure note explain what made this case unusual and how much more work it required than a typical case?
Often confused with 52
CPT modifier · Payment & components · original CureAdvantage explanation · CMS reference: Medicare Claims Processing Manual, Ch. 12, §20.4.6
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Modifier 24
Unrelated visit after surgery
Marks an evaluation and management visit that falls inside a surgical global period but is for a problem unrelated to the surgery, so it should not be treated as routine follow-up care included in the surgical package.
Check: Do the diagnosis and the note show the visit was for something other than the surgery or its complications?
CPT modifier · Surgery & global period · original CureAdvantage explanation · CMS reference: Medicare Claims Processing Manual, Ch. 12, §30.6.6
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Modifier 25
Separate visit on the same day as a procedure
Shows that, on the same day as a procedure or other service, the practitioner also provided an evaluation and management service that goes beyond the routine evaluation that normally comes with that procedure. It is appended to the E/M code, not to the procedure.
Check: Does the E/M documentation stand on its own, showing work beyond the usual pre-procedure assessment for the procedure billed that day?
Often confused with 59, 57, 24
Compare: Modifier 25 vs 59
CPT modifier · Surgery & global period · original CureAdvantage explanation · CMS reference: Medicare NCCI Policy Manual 2026, Chapter I
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Modifier 26
Professional component only
Used when only the professional part of a service that has separate professional and technical parts is billed, typically the interpretation and written report. The technical part (equipment, staff, supplies) is billed separately, often with modifier TC.
Check: Does the service have a professional/technical split, and are you billing only the interpretation and report?
Often confused with TC
CPT modifier · Payment & components · original CureAdvantage explanation · CMS reference: Medicare Claims Processing Manual, Ch. 12 (HPSA bonus instructions identify modifier 26 as the professional component and TC as the technical component)
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Modifier 50
Same procedure on both sides
Indicates that the same procedure was performed on both sides of the body during the same session. Medicare has specific bilateral surgery rules, and some payers prefer separate lines with RT and LT instead.
Check: Is the code already defined as bilateral, and which reporting format (one line with 50, or two lines with RT and LT) does this payer require?
Often confused with LT, RT, 51
CPT modifier · Surgery & global period · original CureAdvantage explanation · CMS reference: Medicare Claims Processing Manual, Ch. 12, §40.7
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Modifier 51
Additional procedures in the same session
Identifies additional procedures performed in the same operative session by the same practitioner so that the payer’s multiple-procedure rules can be applied to them.
Check: Does this payer want 51 reported, or does it apply multiple-procedure rules on its own? Are the additional procedures ones that allow separate reporting?
CPT modifier · Surgery & global period · original CureAdvantage explanation · CMS reference: Medicare Claims Processing Manual, Ch. 12, §40.6
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Modifier 52
Service cut short by choice
Shows that a service was reduced or partly eliminated at the practitioner’s discretion, while the code still best describes what was done. CMS states it cannot be used to report a partial E/M visit.
Check: What portion of the service was not performed, and is it documented? Is the service an E/M visit (in which case 52 does not apply)?
Often confused with 22
CPT modifier · Payment & components · original CureAdvantage explanation · CMS reference: Medicare Claims Processing Manual, Ch. 12, §20.4.6
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Modifier 54
Surgery only, another practitioner does follow-up
Used when a surgeon performs the operation but hands postoperative care to another practitioner, so the global surgical payment is split between them.
Check: Is the transfer of postoperative care documented and agreed, and does the other practitioner bill the follow-up care with 55?
Often confused with 55
CPT modifier · Surgery & global period · original CureAdvantage explanation · CMS reference: Medicare Claims Processing Manual, Ch. 12, §40.2
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Modifier 55
Postoperative care only
Used by the practitioner who provides only the follow-up care after someone else performed the surgery.
Check: Is the date care was transferred documented, and did the surgeon report the procedure with 54?
Often confused with 54
CPT modifier · Surgery & global period · original CureAdvantage explanation · CMS reference: Medicare Claims Processing Manual, Ch. 12, §40.2
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Modifier 57
Visit where the decision for major surgery was made
Identifies the E/M visit at which the decision to perform a major surgery was made, when that visit falls close enough to the surgery to otherwise be treated as part of the surgical package.
Check: Does the procedure carry a major (90-day) global period, and does the note document the decision to operate?
Often confused with 25
CPT modifier · Surgery & global period · original CureAdvantage explanation · CMS reference: Medicare Claims Processing Manual, Ch. 12, §30.6.6
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Modifier 58
Planned or staged follow-on procedure
Marks a procedure performed during a global period that was planned in advance, is more extensive than the original procedure, or is therapy that follows a diagnostic procedure.
Check: Does the documentation show the second procedure was planned or staged at the time of the first?
CPT modifier · Surgery & global period · original CureAdvantage explanation · CMS reference: Medicare Claims Processing Manual, Ch. 12, §40.2
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Modifier 59
Distinct non-E/M service
Shows that two services that are not normally reported together were genuinely separate on this occasion, for example because of a different session, site or lesion. It is not used on E/M services, and CMS asks for a more specific X modifier (XE, XS, XP or XU) when one fits.
Check: Does the record show why the services were distinct, and would XE, XS, XP or XU describe the situation more precisely?
Often confused with 25, XS, XU, XE, XP, 51, 76, 91
Compare: Modifier 25 vs 59 · Modifier 59 vs XS · Modifier 59 vs XU
CPT modifier · Distinct & repeat services · original CureAdvantage explanation · CMS reference: CMS MLN1783722, Proper Use of Modifiers 59, XE, XP, XS & XU (April 2026)
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Modifier 62
Two surgeons, one procedure
Used when two surgeons, usually of different specialties, each perform a distinct part of a single procedure, and each reports the same procedure code.
Check: Does the payer allow co-surgery for this procedure, and does each surgeon’s note describe the part they performed?
CPT modifier · Surgery & global period · original CureAdvantage explanation · CMS reference: Medicare Claims Processing Manual, Ch. 12, §40.8
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Modifier 66
Team surgery across specialties
Used when a team of practitioners from different specialties performs a highly complex procedure together.
Check: Does the payer recognize team surgery for this procedure, and is each team member’s role documented?
Often confused with 62
CPT modifier · Surgery & global period · original CureAdvantage explanation · CMS reference: Medicare Claims Processing Manual, Ch. 12, §40.8
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Modifier 76
Same procedure repeated, same practitioner
Indicates that a procedure or service was repeated on the same day by the same practitioner. CMS notes that it does not bypass NCCI procedure-to-procedure edits.
Check: Why was the repeat needed, and is each performance documented separately with its time?
Often confused with 77, 91, 59
CPT modifier · Distinct & repeat services · original CureAdvantage explanation · CMS reference: Medicare NCCI Policy Manual 2026, Chapter I
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Modifier 77
Same procedure repeated, different practitioner
Indicates that a procedure or service was repeated on the same day by a different practitioner. Like 76, CMS notes that it does not bypass NCCI edits.
Check: Is it clear who performed the first and the repeat service, and why the repeat was needed?
Often confused with 76
CPT modifier · Distinct & repeat services · original CureAdvantage explanation · CMS reference: Medicare NCCI Policy Manual 2026, Chapter I
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Modifier 78
Return to the OR for a related problem
Marks an unplanned return to the operating or procedure room during a global period for a procedure related to the first one, such as treating a complication.
Check: Was the return unplanned, and is the new procedure related to the original surgery?
CPT modifier · Surgery & global period · original CureAdvantage explanation · CMS reference: Medicare Claims Processing Manual, Ch. 12, §40.2
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Modifier 79
New, unrelated procedure after surgery
Marks a procedure performed during a global period that is unrelated to the original surgery, so it is not treated as part of that surgical package.
Check: Do the diagnosis and documentation show the procedure is unrelated to the original surgery?
Often confused with 24, 58, 78
CPT modifier · Surgery & global period · original CureAdvantage explanation · CMS reference: Medicare Claims Processing Manual, Ch. 12, §40.2
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Modifier 80
Physician assisting the whole procedure
Used when a physician assists the primary surgeon throughout a procedure.
Check: Does the payer allow an assistant at surgery for this procedure, and is the assistant’s role documented?
Often confused with 81, 82, AS
CPT modifier · Surgery & global period · original CureAdvantage explanation · CMS reference: Medicare Claims Processing Manual, Ch. 12, §20.4.3
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Modifier 81
Minimal assistance at surgery
Used when an assistant is needed for only a limited part of a procedure rather than the whole operation.
Check: Is the limited portion the assistant covered documented, and does the payer allow an assistant for this procedure?
Often confused with 80
CPT modifier · Surgery & global period · original CureAdvantage explanation · CMS reference: Medicare Claims Processing Manual, Ch. 12, §20.4.3
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Modifier 82
Teaching-setting assist, no resident available
Used in teaching settings when a physician assists at surgery because a qualified resident was not available.
Check: Is the unavailability of a qualified resident documented as the teaching-setting rules require?
Often confused with 80
CPT modifier · Surgery & global period · original CureAdvantage explanation · CMS reference: Medicare Claims Processing Manual, Ch. 12, §100.1.7
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Modifier 91
Repeated lab test for a new result
Identifies a clinical laboratory test repeated on the same day because a new, medically necessary result was needed.
Check: Was the repeat medically reasonable and necessary, and does the order or record show why a new result was needed?
CPT modifier · Distinct & repeat services · original CureAdvantage explanation · CMS reference: Medicare NCCI Policy Manual 2026, Chapter I
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Modifier 95
Telehealth by live audio and video
Shows that the service was delivered over a live two-way audio-and-video connection. How Medicare uses it depends on the claim type and setting, so check current CMS telehealth instructions.
Check: Which claim type is this? CMS’s telehealth booklet uses 95 on institutional claims for outpatient therapy by hospital-employed therapists and describes professional claims in terms of place-of-service codes 02 and 10.
Compare: Modifier 95 vs GT
CPT modifier · Telehealth · original CureAdvantage explanation · CMS reference: CMS MLN901705, Telehealth & Remote Monitoring (December 2025)
All HCPCS Level II Modifiers
HCPCS Level II modifiers are two-character codes maintained by an editorial panel that includes CMS and published in CMS’s quarterly HCPCS files. The 384 modifiers below, 364 active and 20 terminated, are shown with CMS’s own description text, unchanged, and the dates from the file.
A modifiers 33
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Modifier A1
Dressing for one wound
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Modifier A2
Dressing for two wounds
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Modifier A3
Dressing for three wounds
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Modifier A4
Dressing for four wounds
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Modifier A5
Dressing for five wounds
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Modifier A6
Dressing for six wounds
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Modifier A7
Dressing for seven wounds
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Modifier A8
Dressing for eight wounds
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Modifier A9
Dressing for nine or more wounds
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Modifier AA
Anesthesia services performed personally by anesthesiologist
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Modifier AB
Audiology service furnished personally by an audiologist without a physician/npp order for non-acute hearing assessment unrelated to disequilibrium, or hearing aids, or examinations for the purpose of prescribing, fitting, or changing hearing aids; service may be performed once every 12 months, per beneficiary
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Modifier AC
Initial onboarding support payment for access beneficiary enrollment, device/app setup, and care coordination activities; first month only; once per beneficiary per track
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Modifier AD
Medical supervision by a physician: more than four concurrent anesthesia procedures
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Modifier AE
Registered dietician
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Modifier AF
Specialty physician
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Modifier AG
Primary physician
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Modifier AH
Clinical psychologist
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Modifier AI
Principal physician of record
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Modifier AJ
Clinical social worker
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Modifier AK
Non participating physician
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Modifier AM
Physician, team member service
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Modifier AO
Alternate payment method declined by provider of service
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Modifier AP
Determination of refractive state was not performed in the course of diagnostic ophthalmological examination
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Modifier AQ
Physician providing a service in an unlisted health professional shortage area (hpsa)
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Modifier AR
Physician provider services in a physician scarcity area
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Modifier AS
Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery
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Modifier AT
Acute treatment (this modifier should be used when reporting service 98940, 98941, 98942)
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Modifier AU
Item furnished in conjunction with a urological, ostomy, or tracheostomy supply
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Modifier AV
Item furnished in conjunction with a prosthetic device, prosthetic or orthotic
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Modifier AW
Item furnished in conjunction with a surgical dressing
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Modifier AX
Item furnished in conjunction with dialysis services
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Modifier AY
Item or service furnished to an esrd patient that is not for the treatment of esrd
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Modifier AZ
Physician providing a service in a dental health professional shortage area for the purpose of an electronic health record incentive payment
B modifiers 6
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Modifier BA
Item furnished in conjunction with parenteral enteral nutrition (pen) services
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Modifier BL
Special acquisition of blood and blood products
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Modifier BO
Orally administered nutrition, not by feeding tube
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Modifier BP
The beneficiary has been informed of the purchase and rental options and has elected to purchase the item
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Modifier BR
The beneficiary has been informed of the purchase and rental options and has elected to rent the item
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Modifier BU
The beneficiary has been informed of the purchase and rental options and after 30 days has not informed the supplier of his/her decision
C modifiers 20
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Modifier CA
Procedure payable only in the inpatient setting when performed emergently on an outpatient who expires prior to admission
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Modifier CB
Service ordered by a renal dialysis facility (rdf) physician as part of the esrd beneficiary's dialysis benefit, is not part of the composite rate, and is separately reimbursable
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Modifier CC
Procedure code change (use 'cc' when the procedure code submitted was changed either for administrative reasons or because an incorrect code was filed)
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Modifier CD
Amcc test has been ordered by an esrd facility or mcp physician that is part of the composite rate and is not separately billable
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Modifier CE
Amcc test has been ordered by an esrd facility or mcp physician that is a composite rate test but is beyond the normal frequency covered under the rate and is separately reimbursable based on medical necessity
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Modifier CF
Amcc test has been ordered by an esrd facility or mcp physician that is not part of the composite rate and is separately billable
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Modifier CG
Policy criteria applied
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Modifier CH
0 percent impaired, limited or restricted
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Modifier CI
At least 1 percent but less than 20 percent impaired, limited or restricted
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Modifier CJ
At least 20 percent but less than 40 percent impaired, limited or restricted
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Modifier CK
At least 40 percent but less than 60 percent impaired, limited or restricted
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Modifier CL
At least 60 percent but less than 80 percent impaired, limited or restricted
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Modifier CM
At least 80 percent but less than 100 percent impaired, limited or restricted
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Modifier CN
100 percent impaired, limited or restricted
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Modifier CO
Outpatient occupational therapy services furnished in whole or in part by an occupational therapy assistant
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Modifier CP
Adjunctive service related to a procedure assigned to a comprehensive ambulatory payment classification (c-apc) procedure, but reported on a different claim
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Modifier CQ
Outpatient physical therapy services furnished in whole or in part by a physical therapist assistant
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Modifier CR
Catastrophe/disaster related
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Modifier CS
Cost-sharing waived for specified covid-19 testing-related services that result in and order for or administration of a covid-19 test and/or used for cost-sharing waived preventive services furnished via telehealth in rural health clinics and federally qualified health centers during the covid-19 public health emergency
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Modifier CT
Computed tomography services furnished using equipment that does not meet each of the attributes of the national electrical manufacturers association (nema) xr-29-2013 standard
D modifiers 1
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Modifier DA
Oral health assessment by a licensed health professional other than a dentist
E modifiers 16
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Modifier E1
Upper left, eyelid
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Modifier E2
Lower left, eyelid
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Modifier E3
Upper right, eyelid
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Modifier E4
Lower right, eyelid
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Modifier EA
Erythropoietic stimulating agent (esa) administered to treat anemia due to anti-cancer chemotherapy
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Modifier EB
Erythropoietic stimulating agent (esa) administered to treat anemia due to anti-cancer radiotherapy
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Modifier EC
Erythropoietic stimulating agent (esa) administered to treat anemia not due to anti-cancer radiotherapy or anti-cancer chemotherapy
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Modifier ED
Hematocrit level has exceeded 39% (or hemoglobin level has exceeded 13.0 g/dl) for 3 or more consecutive billing cycles immediately prior to and including the current cycle
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Modifier EE
Hematocrit level has not exceeded 39% (or hemoglobin level has not exceeded 13.0 g/dl) for 3 or more consecutive billing cycles immediately prior to and including the current cycle
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Modifier EJ
Subsequent claims for a defined course of therapy, e.g., epo, sodium hyaluronate, infliximab
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Modifier EM
Emergency reserve supply (for esrd benefit only)
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Modifier EP
Service provided as part of medicaid early periodic screening diagnosis and treatment (epsdt) program
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Modifier ER
Items and services furnished by a provider-based, off-campus emergency department
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Modifier ET
Emergency services
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Modifier EX
Expatriate beneficiary
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Modifier EY
No physician or other licensed health care provider order for this item or service
F modifiers 19
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Modifier F1
Left hand, second digit
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Modifier F2
Left hand, third digit
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Modifier F3
Left hand, fourth digit
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Modifier F4
Left hand, fifth digit
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Modifier F5
Right hand, thumb
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Modifier F6
Right hand, second digit
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Modifier F7
Right hand, third digit
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Modifier F8
Right hand, fourth digit
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Modifier F9
Right hand, fifth digit
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Modifier FA
Left hand, thumb
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Modifier FB
Item provided without cost to provider, supplier or practitioner, or full credit received for replaced device (examples, but not limited to, covered under warranty, replaced due to defect, free samples)
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Modifier FC
Partial credit received for replaced device
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Modifier FP
Service provided as part of family planning program
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Modifier FQ
The service was furnished using audio-only communication technology
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Modifier FR
The supervising practitioner was present through two-way, audio/video communication technology
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Modifier FS
Split (or shared) evaluation and management visit
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Modifier FT
Unrelated evaluation and management (e/m) visit on the same day as another e/m visit or during a global procedure (preoperative, postoperative period, or on the same day as the procedure, as applicable). (report when an e/m visit is furnished within the global period but is unrelated, or when one or more additional e/m visits furnished on the same day are unrelated)
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Modifier FX
X-ray taken using film
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Modifier FY
X-ray taken using computed radiography technology/cassette-based imaging
G modifiers 35
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Modifier G0
Telehealth services for diagnosis, evaluation, or treatment, of symptoms of an acute stroke
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Modifier G1
Most recent urr reading of less than 60
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Modifier G2
Most recent urr reading of 60 to 64.9
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Modifier G3
Most recent urr reading of 65 to 69.9
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Modifier G4
Most recent urr reading of 70 to 74.9
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Modifier G5
Most recent urr reading of 75 or greater
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Modifier G6
Esrd patient for whom less than six dialysis sessions have been provided in a month
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Modifier G7
Pregnancy resulted from rape or incest or pregnancy certified by physician as life threatening
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Modifier G8
Monitored anesthesia care (mac) for deep complex, complicated, or markedly invasive surgical procedure
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Modifier G9
Monitored anesthesia care for patient who has history of severe cardio-pulmonary condition
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Modifier GA
Waiver of liability statement issued as required by payer policy, individual case
Compare: GA vs GY vs GZ (and GX)
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Modifier GB
Claim being re-submitted for payment because it is no longer covered under a global payment demonstration
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Modifier GC
This service has been performed in part by a resident under the direction of a teaching physician
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Modifier GD
Units of service exceeds medically unlikely edit value and represents reasonable and necessary services
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Modifier GE
This service has been performed by a resident without the presence of a teaching physician under the primary care exception
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Modifier GF
Non-physician (e.g. nurse practitioner (np), certified registered nurse anesthetist (crna), certified registered nurse (crn), clinical nurse specialist (cns), physician assistant (pa)) services in a critical access hospital
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Modifier GG
Performance and payment of a screening mammogram and diagnostic mammogram on the same patient, same day
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Modifier GH
Diagnostic mammogram converted from screening mammogram on same day
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Modifier GJ
"opt out" physician or practitioner emergency or urgent service
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Modifier GK
Reasonable and necessary item/service associated with a ga or gz modifier
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Modifier GL
Medically unnecessary upgrade provided instead of non-upgraded item, no charge, no advance beneficiary notice (abn)
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Modifier GM
Multiple patients on one ambulance trip
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Modifier GN
Services delivered under an outpatient speech language pathology plan of care
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Modifier GO
Services delivered under an outpatient occupational therapy plan of care
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Modifier GP
Services delivered under an outpatient physical therapy plan of care
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Modifier GQ
Via asynchronous telecommunications system
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Modifier GR
This service was performed in whole or in part by a resident in a department of veterans affairs medical center or clinic, supervised in accordance with va policy
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Modifier GS
Dosage of erythropoietin stimulating agent has been reduced and maintained in response to hematocrit or hemoglobin level
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Modifier GT
Via interactive audio and video telecommunication systems
Compare: Modifier 95 vs GT
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Modifier GU
Waiver of liability statement issued as required by payer policy, routine notice
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Modifier GV
Attending physician not employed or paid under arrangement by the patient's hospice provider
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Modifier GW
Service not related to the hospice patient's terminal condition
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Modifier GX
Notice of liability issued, voluntary under payer policy
Compare: GA vs GY vs GZ (and GX)
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Modifier GY
Item or service statutorily excluded, does not meet the definition of any medicare benefit or, for non-medicare insurers, is not a contract benefit
Compare: GA vs GY vs GZ (and GX)
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Modifier GZ
Item or service expected to be denied as not reasonable and necessary
Compare: GA vs GY vs GZ (and GX)
H modifiers 27
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Modifier H9
Court-ordered
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Modifier HA
Child/adolescent program
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Modifier HB
Adult program, non geriatric
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Modifier HC
Adult program, geriatric
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Modifier HD
Pregnant/parenting women's program
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Modifier HE
Mental health program
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Modifier HF
Substance abuse program
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Modifier HG
Opioid addiction treatment program
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Modifier HH
Integrated mental health/substance abuse program
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Modifier HI
Integrated mental health and intellectual disability/developmental disabilities program
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Modifier HJ
Employee assistance program
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Modifier HK
Specialized mental health programs for high-risk populations
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Modifier HL
Intern
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Modifier HM
Less than bachelor degree level
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Modifier HN
Bachelors degree level
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Modifier HO
Masters degree level
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Modifier HP
Doctoral level
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Modifier HQ
Group setting
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Modifier HR
Family/couple with client present
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Modifier HS
Family/couple without client present
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Modifier HT
Multi-disciplinary team
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Modifier HU
Funded by child welfare agency
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Modifier HV
Funded state addictions agency
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Modifier HW
Funded by state mental health agency
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Modifier HX
Funded by county/local agency
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Modifier HY
Funded by juvenile justice agency
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Modifier HZ
Funded by criminal justice agency
J modifiers 16
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Modifier J1
Competitive acquisition program no-pay submission for a prescription number
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Modifier J2
Competitive acquisition program, restocking of emergency drugs after emergency administration
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Modifier J3
Competitive acquisition program (cap), drug not available through cap as written, reimbursed under average sales price methodology
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Modifier J4
Dmepos item subject to dmepos competitive bidding program that is furnished by a hospital upon discharge
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Modifier J5
Off-the-shelf orthotic subject to dmepos competitive bidding program that is furnished as part of a physical therapist or occupational therapist professional service
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Modifier JA
Administered intravenously
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Modifier JB
Administered subcutaneously
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Modifier JC
Skin substitute used as a graft
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Modifier JD
Skin substitute not used as a graft
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Modifier JE
Administered via dialysate
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Modifier JF
Compounded drug
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Modifier JG
Drug or biological acquired with 340b drug pricing program discount, reported for informational purposes
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Modifier JK
One month supply or less of drug or biological
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Modifier JL
Three month supply of drug or biological
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Modifier JW
Drug amount discarded/not administered to any patient
Compare: JW vs JZ
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Modifier JZ
Zero drug amount discarded/not administered to any patient
Compare: JW vs JZ
K modifiers 31
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Modifier K0
Lower extremity prosthesis functional level 0 - does not have the ability or potential to ambulate or transfer safely with or without assistance and a prosthesis does not enhance their quality of life or mobility.
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Modifier K1
Lower extremity prosthesis functional level 1 - has the ability or potential to use a prosthesis for transfers or ambulation on level surfaces at fixed cadence. typical of the limited and unlimited household ambulator.
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Modifier K2
Lower extremity prosthesis functional level 2 - has the ability or potential for ambulation with the ability to traverse low level environmental barriers such as curbs, stairs or uneven surfaces. typical of the limited community ambulator.
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Modifier K3
Lower extremity prosthesis functional level 3 - has the ability or potential for ambulation with variable cadence. typical of the community ambulator who has the ability to transverse most environmental barriers and may have vocational, therapeutic, or exercise activity that demands prosthetic utilization beyond simple locomotion.
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Modifier K4
Lower extremity prosthesis functional level 4 - has the ability or potential for prosthetic ambulation that exceeds the basic ambulation skills, exhibiting high impact, stress, or energy levels, typical of the prosthetic demands of the child, active adult, or athlete.
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Modifier KA
Add on option/accessory for wheelchair
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Modifier KB
Beneficiary requested upgrade for abn, more than 4 modifiers identified on claim
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Modifier KC
Replacement of special power wheelchair interface
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Modifier KD
Drug or biological infused through dme
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Modifier KE
Bid under round one of the dmepos competitive bidding program for use with non-competitive bid base equipment
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Modifier KF
Item designated by fda as class iii device
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Modifier KG
Dmepos item subject to dmepos competitive bidding program number 1
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Modifier KH
Dmepos item, initial claim, purchase or first month rental
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Modifier KI
Dmepos item, second or third month rental
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Modifier KJ
Dmepos item, parenteral enteral nutrition (pen) pump or capped rental, months four to fifteen
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Modifier KK
Dmepos item subject to dmepos competitive bidding program number 2
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Modifier KL
Dmepos item delivered via mail
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Modifier KM
Replacement of facial prosthesis including new impression/moulage
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Modifier KN
Replacement of facial prosthesis using previous master model
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Modifier KO
Single drug unit dose formulation
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Modifier KP
First drug of a multiple drug unit dose formulation
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Modifier KQ
Second or subsequent drug of a multiple drug unit dose formulation
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Modifier KR
Rental item, billing for partial month
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Modifier KS
Glucose monitor supply for diabetic beneficiary not treated with insulin
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Modifier KT
Beneficiary resides in a competitive bidding area and travels outside that competitive bidding area and receives a competitive bid item
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Modifier KU
Dmepos item subject to dmepos competitive bidding program number 3
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Modifier KV
Dmepos item subject to dmepos competitive bidding program that is furnished as part of a professional service
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Modifier KW
Dmepos item subject to dmepos competitive bidding program number 4
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Modifier KX
Requirements specified in the medical policy have been met
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Modifier KY
Dmepos item subject to dmepos competitive bidding program number 5
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Modifier KZ
New coverage not implemented by managed care
L modifiers 9
-
Modifier L1
Provider attestation that the hospital laboratory test(s) is not packaged under the hospital opps
-
Modifier LC
Left circumflex coronary artery
-
Modifier LD
Left anterior descending coronary artery
-
Modifier LL
Lease/rental (use the 'll' modifier when dme equipment rental is to be applied against the purchase price)
-
Modifier LM
Left main coronary artery
-
Modifier LR
Laboratory round trip
-
Modifier LS
Fda-monitored intraocular lens implant
-
Modifier LT
Left side (used to identify procedures performed on the left side of the body)
-
Modifier LU
Fractionated payment
M modifiers 10
-
Modifier M2
Medicare secondary payer (msp)
-
Modifier MA
Ordering professional is not required to consult a clinical decision support mechanism due to service being rendered to a patient with a suspected or confirmed emergency medical condition
-
Modifier MB
Ordering professional is not required to consult a clinical decision support mechanism due to the significant hardship exception of insufficient internet access
-
Modifier MC
Ordering professional is not required to consult a clinical decision support mechanism due to the significant hardship exception of electronic health record or clinical decision support mechanism vendor issues
-
Modifier MD
Ordering professional is not required to consult a clinical decision support mechanism due to the significant hardship exception of extreme and uncontrollable circumstances
-
Modifier ME
The order for this service adheres to appropriate use criteria in the clinical decision support mechanism consulted by the ordering professional
-
Modifier MF
The order for this service does not adhere to the appropriate use criteria in the clinical decision support mechanism consulted by the ordering professional
-
Modifier MG
The order for this service does not have applicable appropriate use criteria in the qualified clinical decision support mechanism consulted by the ordering professional
-
Modifier MH
Unknown if ordering professional consulted a clinical decision support mechanism for this service, related information was not provided to the furnishing professional or provider
-
Modifier MS
Six month maintenance and servicing fee for reasonable and necessary parts and labor which are not covered under any manufacturer or supplier warranty
N modifiers 6
-
Modifier N1
Group 1 oxygen coverage criteria met
-
Modifier N2
Group 2 oxygen coverage criteria met
-
Modifier N3
Group 3 oxygen coverage criteria met
-
Modifier NB
Nebulizer system, any type, fda-cleared for use with specific drug
-
Modifier NR
New when rented (use the 'nr' modifier when dme which was new at the time of rental is subsequently purchased)
-
Modifier NU
New equipment
P modifiers 17
-
Modifier P1
A normal healthy patient
-
Modifier P2
A patient with mild systemic disease
-
Modifier P3
A patient with severe systemic disease
-
Modifier P4
A patient with severe systemic disease that is a constant threat to life
-
Modifier P5
A moribund patient who is not expected to survive without the operation
-
Modifier P6
A declared brain-dead patient whose organs are being removed for donor purposes
-
Modifier PA
Surgical or other invasive procedure on wrong body part
-
Modifier PB
Surgical or other invasive procedure on wrong patient
-
Modifier PC
Wrong surgery or other invasive procedure on patient
-
Modifier PD
Diagnostic or related non diagnostic item or service provided in a wholly owned or operated entity to a patient who is admitted as an inpatient within 3 days
-
Modifier PI
Positron emission tomography (pet) or pet/computed tomography (ct) to inform the initial treatment strategy of tumors that are biopsy proven or strongly suspected of being cancerous based on other diagnostic testing
-
Modifier PL
Progressive addition lenses
-
Modifier PM
Post mortem
-
Modifier PN
Non-excepted service provided at an off-campus, outpatient, provider-based department of a hospital
-
Modifier PO
Excepted service provided at an off-campus, outpatient, provider-based department of a hospital
-
Modifier PS
Positron emission tomography (pet) or pet/computed tomography (ct) to inform the subsequent treatment strategy of cancerous tumors when the beneficiary's treating physician determines that the pet study is needed to inform subsequent anti-tumor strategy
-
Modifier PT
Colorectal cancer screening test; converted to diagnostic test or other procedure
Q modifiers 32
-
Modifier Q0
Investigational clinical service provided in a clinical research study that is in an approved clinical research study
-
Modifier Q1
Routine clinical service provided in a clinical research study that is in an approved clinical research study
-
Modifier Q2
Demonstration procedure/service
-
Modifier Q3
Live kidney donor surgery and related services
-
Modifier Q4
Service for ordering/referring physician qualifies as a service exemption
-
Modifier Q5
Service furnished under a reciprocal billing arrangement by a substitute physician or by a substitute physical therapist furnishing outpatient physical therapy services in a health professional shortage area, a medically underserved area, or a rural area
-
Modifier Q6
Service furnished under a fee-for-time compensation arrangement by a substitute physician or by a substitute physical therapist furnishing outpatient physical therapy services in a health professional shortage area, a medically underserved area, or a rural area
-
Modifier Q7
One class a finding
-
Modifier Q8
Two class b findings
-
Modifier Q9
One class b and two class c findings
-
Modifier QA
Prescribed amounts of stationary oxygen for daytime use while at rest and nighttime use differ and the average of the two amounts is less than 1 liter per minute (lpm)
-
Modifier QB
Prescribed amounts of stationary oxygen for daytime use while at rest and nighttime use differ and the average of the two amounts exceeds 4 liters per minute (lpm) and portable oxygen is prescribed
-
Modifier QC
Single channel monitoring
-
Modifier QD
Recording and storage in solid state memory by a digital recorder
-
Modifier QE
Prescribed amount of stationary oxygen while at rest is less than 1 liter per minute (lpm)
-
Modifier QF
Prescribed amount of stationary oxygen while at rest exceeds 4 liters per minute (lpm) and portable oxygen is prescribed
-
Modifier QG
Prescribed amount of stationary oxygen while at rest is greater than 4 liters per minute (lpm)
-
Modifier QH
Oxygen conserving device is being used with an oxygen delivery system
-
Modifier QJ
Services/items provided to a prisoner or patient in state or local custody, however the state or local government, as applicable, meets the requirements in 42 cfr 411.4 (b)
-
Modifier QK
Medical direction of two, three, or four concurrent anesthesia procedures involving qualified individuals
-
Modifier QL
Patient pronounced dead after ambulance called
-
Modifier QM
Ambulance service provided under arrangement by a provider of services
-
Modifier QN
Ambulance service furnished directly by a provider of services
-
Modifier QP
Documentation 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 g0060.
-
Modifier QQ
Ordering professional consulted a qualified clinical decision support mechanism for this service and the related data was provided to the furnishing professional
-
Modifier QR
Prescribed amounts of stationary oxygen for daytime use while at rest and nighttime use differ and the average of the two amounts is greater than 4 liters per minute (lpm)
-
Modifier QS
Monitored anesthesia care service
-
Modifier QT
Recording and storage on tape by an analog tape recorder
-
Modifier QW
Clia waived test
-
Modifier QX
Crna service: with medical direction by a physician
-
Modifier QY
Medical direction of one certified registered nurse anesthetist (crna) by an anesthesiologist
-
Modifier QZ
Crna service: without medical direction by a physician
R modifiers 8
-
Modifier RA
Replacement of a dme, orthotic or prosthetic item
-
Modifier RB
Replacement of a part of a dme, orthotic or prosthetic item furnished as part of a repair
-
Modifier RC
Right coronary artery
-
Modifier RD
Drug provided to beneficiary, but not administered "incident-to"
-
Modifier RE
Furnished in full compliance with fda-mandated risk evaluation and mitigation strategy (rems)
-
Modifier RI
Ramus intermedius coronary artery
-
Modifier RR
Rental (use the 'rr' modifier when dme is to be rented)
-
Modifier RT
Right side (used to identify procedures performed on the right side of the body)
S modifiers 21
-
Modifier SA
Nurse practitioner rendering service in collaboration with a physician
-
Modifier SB
Nurse midwife
-
Modifier SC
Medically necessary service or supply
-
Modifier SD
Services provided by registered nurse with specialized, highly technical home infusion training
-
Modifier SE
State and/or federally-funded programs/services
-
Modifier SF
Second opinion ordered by a professional review organization (pro) per section 9401, p.l. 99-272 (100% reimbursement - no medicare deductible or coinsurance)
-
Modifier SG
Ambulatory surgical center (asc) facility service
-
Modifier SH
Second concurrently administered infusion therapy
-
Modifier SJ
Third or more concurrently administered infusion therapy
-
Modifier SK
Member of high risk population (use only with codes for immunization)
-
Modifier SL
State supplied vaccine
-
Modifier SM
Second surgical opinion
-
Modifier SN
Third surgical opinion
-
Modifier SQ
Item ordered by home health
-
Modifier SS
Home infusion services provided in the infusion suite of the iv therapy provider
-
Modifier ST
Related to trauma or injury
-
Modifier SU
Procedure performed in physician's office (to denote use of facility and equipment)
-
Modifier SV
Pharmaceuticals delivered to patient's home but not utilized
-
Modifier SW
Services provided by a certified diabetic educator
-
Modifier SY
Persons who are in close contact with member of high-risk population (use only with codes for immunization)
-
Modifier SZ
Habilitative services
T modifiers 30
-
Modifier T1
Left foot, second digit
-
Modifier T2
Left foot, third digit
-
Modifier T3
Left foot, fourth digit
-
Modifier T4
Left foot, fifth digit
-
Modifier T5
Right foot, great toe
-
Modifier T6
Right foot, second digit
-
Modifier T7
Right foot, third digit
-
Modifier T8
Right foot, fourth digit
-
Modifier T9
Right foot, fifth digit
-
Modifier TA
Left foot, great toe
-
Modifier TB
Drug or biological acquired with 340b drug pricing program discount, reported for informational purposes
-
Modifier TC
Technical component; under certain circumstances, a charge may be made for the technical component alone; under those circumstances the technical component charge is identified by adding modifier 'tc' to the usual procedure number; technical component charges are institutional charges and not billed separately by physicians; however, portable x-ray suppliers only bill for technical component and should utilize modifier tc; the charge data from portable x-ray suppliers will then be used to build customary and prevailing profiles
-
Modifier TD
Rn
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Modifier TE
Lpn/lvn
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Modifier TF
Intermediate level of care
-
Modifier TG
Complex/high tech level of care
-
Modifier TH
Obstetrical treatment/services, prenatal or postpartum
-
Modifier TJ
Program group, child and/or adolescent
-
Modifier TK
Extra patient or passenger, non-ambulance
-
Modifier TL
Early intervention/individualized family service plan (ifsp)
-
Modifier TM
Individualized education program (iep)
-
Modifier TN
Rural/outside providers' customary service area
-
Modifier TP
Medical transport, unloaded vehicle
-
Modifier TQ
Basic life support transport by a volunteer ambulance provider
-
Modifier TR
School-based individualized education program (iep) services provided outside the public school district responsible for the student
-
Modifier TS
Follow-up service
-
Modifier TT
Individualized service provided to more than one patient in same setting
-
Modifier TU
Special payment rate, overtime
-
Modifier TV
Special payment rates, holidays/weekends
-
Modifier TW
Back-up equipment
U modifiers 24
-
Modifier U1
Medicaid level of care 1, as defined by each state
-
Modifier U2
Medicaid level of care 2, as defined by each state
-
Modifier U3
Medicaid level of care 3, as defined by each state
-
Modifier U4
Medicaid level of care 4, as defined by each state
-
Modifier U5
Medicaid level of care 5, as defined by each state
-
Modifier U6
Medicaid level of care 6, as defined by each state
-
Modifier U7
Medicaid level of care 7, as defined by each state
-
Modifier U8
Medicaid level of care 8, as defined by each state
-
Modifier U9
Medicaid level of care 9, as defined by each state
-
Modifier UA
Medicaid level of care 10, as defined by each state
-
Modifier UB
Medicaid level of care 11, as defined by each state
-
Modifier UC
Medicaid level of care 12, as defined by each state
-
Modifier UD
Medicaid level of care 13, as defined by each state
-
Modifier UE
Used durable medical equipment
-
Modifier UF
Services provided in the morning
-
Modifier UG
Services provided in the afternoon
-
Modifier UH
Services provided in the evening
-
Modifier UJ
Services provided at night
-
Modifier UK
Services provided on behalf of the client to someone other than the client (collateral relationship)
-
Modifier UN
Two patients served
-
Modifier UP
Three patients served
-
Modifier UQ
Four patients served
-
Modifier UR
Five patients served
-
Modifier US
Six or more patients served
V modifiers 11
-
Modifier V1
Demonstration modifier 1
-
Modifier V2
Demonstration modifier 2
-
Modifier V3
Demonstration modifier 3
-
Modifier V4
Demonstration modifier 4
-
Modifier V5
Vascular catheter (alone or with any other vascular access)
-
Modifier V6
Arteriovenous graft (or other vascular access not including a vascular catheter)
-
Modifier V7
Arteriovenous fistula only (in use with two needles)
-
Modifier V8
Infection present
-
Modifier V9
No infection present
-
Modifier VM
Medicare diabetes prevention program (mdpp) virtual make-up session
-
Modifier VP
Aphakic patient
X modifiers 9
-
Modifier X1
Continuous/broad services: for reporting services by clinicians, who provide the principal care for a patient, with no planned endpoint of the relationship; services in this category represent comprehensive care, dealing with the entire scope of patient problems, either directly or in a care coordination role; reporting clinician service examples include, but are not limited to: primary care, and clinicians providing comprehensive care to patients in addition to specialty care
-
Modifier X2
Continuous/focused services: for reporting services by clinicians whose expertise is needed for the ongoing management of a chronic disease or a condition that needs to be managed and followed with no planned endpoint to the relationship; reporting clinician service examples include but are not limited to: a rheumatologist taking care of the patient's rheumatoid arthritis longitudinally but not providing general primary care services
-
Modifier X3
Episodic/broad services: for reporting services by clinicians who have broad responsibility for the comprehensive needs of the patient that is limited to a defined period and circumstance such as a hospitalization; reporting clinician service examples include but are not limited to the hospitalist's services rendered providing comprehensive and general care to a patient while admitted to the hospital
-
Modifier X4
Episodic/focused services: for reporting services by clinicians who provide focused care on particular types of treatment limited to a defined period and circumstance; the patient has a problem, acute or chronic, that will be treated with surgery, radiation, or some other type of generally time-limited intervention; reporting clinician service examples include but are not limited to, the orthopedic surgeon performing a knee replacement and seeing the patient through the postoperative period
-
Modifier X5
Diagnostic services requested by another clinician: for reporting services by a clinician who furnishes care to the patient only as requested by another clinician or subsequent and related services requested by another clinician; this modifier is reported for patient relationships that may not be adequately captured by the above alternative categories; reporting clinician service examples include but are not limited to, the radiologist's interpretation of an imaging study requested by another clinician
-
Modifier XE
Separate encounter, a service that is distinct because it occurred during a separate encounter
Compare: Modifier 59 vs XS · Modifier 59 vs XU
-
Modifier XP
Separate practitioner, a service that is distinct because it was performed by a different practitioner
Compare: Modifier 59 vs XS · Modifier 59 vs XU
-
Modifier XS
Separate structure, a service that is distinct because it was performed on a separate organ/structure
Compare: Modifier 59 vs XS
-
Modifier XU
Unusual non-overlapping service, the use of a service that is distinct because it does not overlap usual components of the main service
Compare: Modifier 59 vs XU
Z modifiers 3
-
Modifier ZA
Novartis/sandoz
-
Modifier ZB
Pfizer/hospira
-
Modifier ZC
Merck/samsung bioepis
Which Modifier? Side-by-Side Comparisons
These pairs come up repeatedly in search suggestions and in CMS guidance. Each comparison says when the difference matters, what each modifier is meant to communicate and what to check, with the CMS source for each point.
Modifier 25 vs 59
Both come up when more than one service is billed for the same day, but they attach to different kinds of service.
-
25
Goes on the E/M visit code when, on the same day as a procedure or other service, the practitioner also provided evaluation and management work beyond the routine assessment that comes with the procedure. The NCCI Policy Manual allows a same-day E/M service that is clearly separate from a minor procedure to be reported with modifier 25.
-
59
Goes on a non-E/M procedure or service to show it was distinct from another non-E/M service it is normally reported with. CMS says modifier 59 should not be appended to an E/M service.
When the difference matters: When a visit and a procedure are billed for the same day, the question is whether the visit was separate from the procedure; that is a modifier 25 question. When two procedures that are normally bundled were both justified, that is a modifier 59 question, or an XE, XS, XP or XU question. Putting 59 on an E/M code is a mix-up CMS rules out directly.
What to verify: Which line is the E/M service? Does the E/M documentation stand on its own? For procedures, what made them distinct: a separate session, site, structure, practitioner or non-overlapping service?
Sources: Medicare NCCI Policy Manual, Chapter I (revision January 1, 2026); CMS MLN1783722, Proper Use of Modifiers 59, XE, XP, XS & XU (April 2026)
Modifier 59 vs XS
XS is one of four HCPCS Level II modifiers, added to the HCPCS file on January 1, 2015, that describe distinct services more specifically than 59.
-
59
A CPT modifier and a general signal that a non-E/M service was distinct from another service it is normally reported with, for any of several reasons, such as a different session, site or lesion.
-
XS
CMS description: “Separate structure, a service that is distinct because it was performed on a separate organ/structure”.
When the difference matters: CMS’s April 2026 guidance says modifier 59 should be used only if no more descriptive modifier is available and 59 best explains the circumstances. When what made the service distinct is that it was performed on a different organ or structure, XS states that reason directly.
What to verify: Does the documentation identify the separate organ or structure? Does this payer accept the X modifiers? Medicaid and commercial payers set their own rules. Neither modifier should be used to get past an edit unless its criteria are met.
Sources: CMS MLN1783722, Proper Use of Modifiers 59, XE, XP, XS & XU (April 2026); CMS October 2026 HCPCS file
Modifier 59 vs XU
XU is the X modifier for a distinct service that does not overlap the usual components of the main service.
-
59
A CPT modifier and a general signal that a non-E/M service was distinct from another service it is normally reported with, for any of several reasons, such as a different session, site or lesion.
-
XU
CMS description: “Unusual non-overlapping service, the use of a service that is distinct because it does not overlap usual components of the main service”.
When the difference matters: CMS says to choose the most descriptive modifier and to use 59 only when none of the more specific ones fits. XU is the one to consider when the distinction is that the services do not overlap, rather than a separate encounter (XE), structure (XS) or practitioner (XP).
What to verify: Does the documentation show why the service does not overlap the main service? Would XE, XS or XP describe the situation more exactly? Does this payer accept the X modifiers?
Sources: CMS MLN1783722, Proper Use of Modifiers 59, XE, XP, XS & XU (April 2026); CMS October 2026 HCPCS file
GA vs GY vs GZ (and GX)
These HCPCS Level II modifiers tell Medicare about liability: whether the patient received a written notice, and what kind of denial is expected.
-
GA
CMS description: “Waiver of liability statement issued as required by payer policy, individual case”. Chapter 30 treats GA as the provider’s statement that a valid written notice (an Advance Beneficiary Notice) was given before the service.
-
GY
CMS description: “Item or service statutorily excluded, does not meet the definition of any medicare benefit or, for non-medicare insurers, is not a contract benefit”.
-
GZ
CMS description: “Item or service expected to be denied as not reasonable and necessary”. Chapter 30 uses GZ for cases where a signed Advance Beneficiary Notice was not obtained.
-
GX
CMS description: “Notice of liability issued, voluntary under payer policy”.
When the difference matters: The split is between a service Medicare may deny as not reasonable and necessary, where the notice decides who is liable (GA if a valid one was given, GZ if a signed one was not obtained), and a service Medicare does not cover by statute or benefit definition (GY). GX marks a notice given voluntarily.
What to verify: Is the service excluded by statute, or expected to be denied as not reasonable and necessary? Was a valid ABN (form CMS-R-131) delivered and signed before the service? For non-Medicare plans, GY’s CMS description also refers to services that are not a contract benefit, so check the plan’s policy.
Sources: CMS October 2026 HCPCS file; Medicare Claims Processing Manual, Chapter 30
JW vs JZ
For Part B drugs from single-dose containers, CMS asks for one of these on the claim: JW for any amount discarded, JZ when nothing was.
-
JW
CMS description: “Drug amount discarded/not administered to any patient”.
-
JZ
CMS description: “Zero drug amount discarded/not administered to any patient”.
When the difference matters: CMS’s FAQs say providers must report JW for discarded amounts of separately payable Part B drugs from single-dose containers and, beginning no later than July 1, 2023, must report JZ on those claims when there is no discarded amount. The modifiers apply only to single-dose container drugs.
What to verify: Is the drug from a single-dose container and separately payable under Part B? Is the discarded amount documented in the medical record, as the FAQs require? Does the JW line report the discarded amount?
Sources: CMS JW and JZ Modifier Policy FAQs; CMS October 2026 HCPCS file
Modifier 95 vs GT
Both describe care delivered by live audio and video. Which one Medicare expects depends on the type of claim.
-
95
A CPT modifier showing the service was delivered over a live two-way audio-and-video connection. CMS’s telehealth booklet uses it on institutional claims for outpatient therapy furnished via telehealth by physical therapists, occupational therapists or speech-language pathologists employed by hospitals.
-
GT
CMS description: “Via interactive audio and video telecommunication systems”. The same booklet says distant-site practitioners billing under the critical access hospital optional payment method (Method II) submit institutional claims with GT.
When the difference matters: For professional claims, the booklet describes telehealth billing in terms of place-of-service codes rather than these modifiers: as of January 1, 2024, POS 02 when the patient is not at home and POS 10 when the patient is at home. Medicaid and commercial payers set their own telehealth modifier rules.
What to verify: Is this an institutional or a professional claim? Which setting and payment method apply? What does this payer’s current telehealth policy require?
Sources: CMS MLN901705, Telehealth & Remote Monitoring (December 2025)
Before You Add a Modifier: A Checklist
- What was actually performed? Start from the documentation, not from the edit or denial you are trying to resolve.
- What circumstance is the modifier reporting? A modifier adds information, such as a separate session, a different site or a notice given to the patient. If you cannot name that circumstance, the modifier probably does not belong.
- Does the record support it? Each modifier on this page lists the question the documentation should answer.
- Is there a more specific option? CMS says modifier 59 should be used only when no more descriptive modifier, such as XE, XS, XP or XU, fits.
- Does Medicare have its own rule? Several modifiers are tied to Medicare instructions, for example the ABN rules behind GA and GZ or the discarded-drug rules behind JW and JZ.
- Does this payer recognize it? Medicaid programs and commercial payers publish their own modifier policies, and they can differ from Medicare’s.
- Does the claim need anything else? Some situations also need a notice, an attachment or specific units on the line.
A modifier does not guarantee payment. CMS specifically warns against using 59, the X modifiers and other NCCI-associated modifiers to get past an edit without meeting their criteria.
Modifier Questions
What is modifier 25?
Modifier 25 is a CPT modifier added to an evaluation and management (E/M) code to show that, on the same day as a procedure or other service, the practitioner also provided E/M work beyond the routine assessment that comes with that procedure. See the modifier 25 guide and the 25 vs 59 comparison.
What is modifier 59?
Modifier 59 is a CPT modifier used on a non-E/M service to show it was distinct from another service it is normally reported with, for example because of a different session, site or lesion. CMS says to use it only when no more descriptive modifier, such as XE, XS, XP or XU, fits. See the modifier 59 guide.
What is the difference between modifier 25 and modifier 59?
Modifier 25 goes on an E/M visit that was separate from a same-day procedure. Modifier 59 goes on a non-E/M procedure or service, and CMS says it should not be appended to an E/M service. See the full comparison.
Should I use modifier 59 or XS?
CMS says to use modifier 59 only if no more descriptive modifier is available. If the service was distinct because it was performed on a separate organ or structure, XS describes that more precisely. Check that the payer accepts the X modifiers. See 59 vs XS.
Does Medicare still accept modifier 59?
Yes. CMS’s April 2026 guidance on modifiers 59, XE, XP, XS and XU still covers modifier 59 and allows it on either code of an NCCI procedure-to-procedure pair, but says to use it only when no more descriptive modifier fits.
What is modifier 95?
Modifier 95 is a CPT modifier showing a service was delivered by live audio and video. How Medicare uses it depends on the claim type. See 95 vs GT.
What is modifier JW?
JW is a HCPCS Level II modifier. CMS describes it as “Drug amount discarded/not administered to any patient”. It reports the discarded amount of a separately payable Part B drug from a single-dose container. See JW vs JZ.
What is modifier JZ?
JZ is a HCPCS Level II modifier. CMS describes it as “Zero drug amount discarded/not administered to any patient”. Medicare requires it on claims for separately payable Part B drugs from single-dose containers when no amount was discarded.
What is modifier GA?
GA is a HCPCS Level II modifier. CMS describes it as “Waiver of liability statement issued as required by payer policy, individual case”. Medicare treats it as the provider’s statement that a valid Advance Beneficiary Notice was given before the service. See GA vs GY vs GZ.
What is modifier GY?
GY is a HCPCS Level II modifier. CMS describes it as “Item or service statutorily excluded, does not meet the definition of any medicare benefit or, for non-medicare insurers, is not a contract benefit”.
What is modifier GZ?
GZ is a HCPCS Level II modifier. CMS describes it as “Item or service expected to be denied as not reasonable and necessary”. Medicare uses it when a signed Advance Beneficiary Notice was not obtained.
What is the difference between CPT and HCPCS modifiers?
CPT modifiers are two-digit numeric codes that belong to the American Medical Association’s CPT code set. HCPCS Level II modifiers are two-character alphanumeric codes maintained by an editorial panel that includes CMS and published in CMS’s quarterly HCPCS files.
Sources and How This Page Was Built
- HCPCS Level II modifiers: CMS October 2026 Alpha-Numeric HCPCS file (file
HCPC2026_OCT_ANWEB_v2.txt, released September 10, 2026). Codes, descriptions and dates are shown as published. The file’s record layout lists the numeric CPT modifiers as AMA-copyrighted and does not include them. - CPT modifier guides: written by CureAdvantage. They summarize what each modifier is used to communicate and link to the CMS document that discusses it. They are not the AMA’s descriptors and are not a licensed copy of the CPT code set.
- Comparisons: MLN1783722, Proper Use of Modifiers 59, XE, XP, XS & XU (April 2026); Medicare NCCI Policy Manual, Chapter I (revision January 1, 2026); Medicare Claims Processing Manual, Chapter 30 (ABN and liability notices); JW and JZ Modifier Policy FAQs; MLN901705, Telehealth & Remote Monitoring (December 2025).
- CPT modifier references: Medicare Claims Processing Manual, Chapter 12 (Physicians/Nonphysician Practitioners) and the NCCI Policy Manual above.
- Categories: assigned by CureAdvantage to make filtering easier. Telehealth, anesthesia and drug categories come from words in CMS’s description text; anatomical-site, liability, distinct-service and therapy categories use fixed lists of codes. A modifier can appear in more than one category, and categories are not a CMS classification.
These rules describe Medicare. Medicaid programs and commercial payers can recognize modifiers differently, so check the payer’s current policy before you bill. This page explains modifiers; it does not decide whether a service is covered or how much it will pay.
Related Resources
For modifier 25 with same-day injections, see the modifier 25 audit guide. For bundled services and procedure-to-procedure edits, see CMS bundling rules. For telehealth place-of-service codes, see POS 02 vs POS 10. Other free references include the ICD-10-CM validity checker and the timely filing limits reference.