Appendix B
Modifiers

A list of the most frequently used CPT (Current Procedural Terminology) modifiers, HCPCS (Health Care Financing Administration's Common Procedure Coding System) modifiers, and local modifiers has been compiled for your reference.

These modifiers and associated nomenclature emanated from three different sources.

For some of these modifiers, additional clarification (shown as indented text) has been added, as well as examples. Other modifiers are self-explanatory; no additional comment is provided.

Modifiers provide the means by which the reporting provider can indicate a service or procedure that has been performed has been altered by some specific circumstance but not changed in its definition or code.

Modifiers may be used to indicate that:

Anesthesia

One of the following modifiers must be reported with anesthesia services to indicate who performed the anesthesia service:

AA - Anesthesia services performed personally by anesthesiologist

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

QJ - Medically directed by a physician: two concurrent procedures (for services prior to January 1, 1995)

QK - Medically directed by a physician: two, three, or four concurrent procedures (effective for services on or after January 1, 1995)

QO - Medically directed by a physician: three concurrent procedures (for services prior to January 1, 1995)

QQ - Medically directed by a physician: four concurrent procedures (for services prior to January 1, 1995)

QY - Anesthesiologist medically directs one CRNA

QX - CRNA service: with medical direction by a physician

QZ - CRNA service: without medical direction by a physician

The following modifier is reported in addition to one of the above modifiers to indicate that monitored anesthesia care was provided:

QS - Monitored anesthesia care service

Global Surgery

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:

24 - 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 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 May 10, 1998. The ICD-9-CM diagnosis code reported is 171.2. The post-operative period designated for excision code 11606 is 10 days.

The patient returns to the office on May 15, 1998 and is treated for contact dermatitis, ICD-9-CM code 692.0. The physician should report the appropriate evaluation and management code followed by the 24 modifier, e.g., 9921224.

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

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

25 - Significant, Separately Identifiable Evaluation and Management Service by the Same Physician on the Day of a Procedure: The physician may need to indicate that on the day a procedure or service identified by a CPT code was performed, the patient's condition required a significant, separately identifiable E/M service above and beyond the usual preoperative and postoperative care associated with the procedure that was performed. The E/M serive may be prompted by the symptom or condition for which the procedure and/or service was provided. As such, different diagnoses are not required for reporting of thre E/M services on the same date. This circumstance may be reported by adding the modifier 25 to the appropriate level of E/M service.

Note: This modifier is not used to report an E/M service that resulted in a decision to perform major surgery. See modifier 57.

Visits by the same physician on the same day as a minor surgery or endoscopy are included in the payment for the procedure, unless a significant, separately identifiable service is also performed. For example, a visit on the same day could be properly billed with the 25 modifier in addition to billing for suturing a scalp wound if a full neurological examination was made for a patient with head trauma. Billing for a visit would not be appropriate if the physician only identified the need for sutures and confirmed allergy and immunization status. In the circumstance when the decision to perform a minor procedure is typically done immediately before the service, (e.g., whether or not sutures are needed to close a wound, whether or not to remove a mole or wart, etc.) it is considered a routine preoperative service and a visit or consultation should not be reported in addition to the procedure.

Effective immediately for dates of service on or after January 1, 1997, separate payment may be made for an initial hospital visit (CPT codes 99221-99223), an initial inpatient consultation (CPT codes 99251-99255) and a hospital discharge service (CPT codes 99238 and 99239) when billed by the same physician for the same date as an inpatient dialysis service (CPT code 90935-90947). It is no longer required that these evaluation and management services be unrelated to the treatment of the patient's ESRD in order for payment to be made. However, the 25 modifier must still be reported with these evaluation and management services in order to indicate that they are significant and separately identifiable services. Physicians may request reviews of previously denied services.

57 - Decision for Surgery. An evaluation and management service that resulted in the initial decision to perform the surgery may be identified by adding modifier 57 to the appropriate level of E/M service.

E/M services on the day before or on the day of major surgery ( 90 day global period) which result in the initial decision to perform the surgery are not included in the global surgery payment. These E/M services may be billed separately and identified with the 57 modifier.

This modifier should not be used for visits furnished during the global period of minor procedures (0 or 10 day global period ) unless the purpose of the visit is a decision for major surgery. This modifier is not used with minor surgeries because the global period for minor surgeries does not include the day prior to the surgery. When the decision to perform the minor procedure is typically done immediately before the service, it is considered a routine preoperative service and a visit or consultation is not billed in addition to the procedure.
See modifier
25.

58 - Staged Procedure or Service by the Same Physician During the Postoperative Period: The physician may need to indicate that the performance of a procedure or service during the postoperative period was planned prospectively at the time of the original procedure. This circumstance may be reported by adding the modifier 58 to the staged procedure.

Note: Medicare policy limits the use of this modifier to staged procedures. The CPT-4 definition of this modifier is broader in scope.

This modifier is not used to report the treatment of a problem that requires a return to the operating room. See modifier 78.

It would not be appropriate to report this modifier for codes which indicate in the terminology "one or more sessions", e.g., 66761, 67141, 67227. These codes are defined by CPT-4 as consisting of one or more sessions. The relative value units represent the work for the total number of sessions necessary for completion of the procedure. Therefore, subsequent sessions performed within the global period of the initial surgery are included in the global fee.

59 - Distinct Procedural Service: Under certain circumstances, a provider may need to indicate that a procedure or service was independent from the services performed on the same day. See Appendix C (Correct Coding Initiative) for more information regarding the use of modifier 59.

78 - Return to the Operating Room for a Related Procedure During the Postoperative Period: The physician may need to indicate that another procedure was performed during the postoperative period of the initial procedure. When this subsequent procedure is related to the first, and requires the use of the operating room, it may be reported by adding the 78 modifier to the related procedure.

When treatment for complications requires a return trip to the operating room, physicians must bill the CPT-4 code that describes the procedure (s) performed during the return trip. If no such code exists, use the unspecified procedure code in the correct series, e.g., 47999 or 64999. In this situation, you must include operative notes with the claim or a narrative description which will allow us to understand the extent of the service performed. The procedure code for the original surgery is not used except when the identical procedure is repeated.

An operating room for this purpose is defined as a place of service specifically equipped and staffed for the sole purpose of performing procedures. The term includes a cardiac catheterization suite, a laser suite, and an endoscopy suite. It does not include a patient's room, a minor treatment room, a recovery room, or an intensive care unit ( unless the patient's condition was so critical there would be insufficient time for transportation to an operating room).

A partial colectomy is performed in the hospital on March 1, 1999. The postoperative designation for this procedure (code 44140) is 90 days.

On March 15, 1999, the patient is returned to the operating room for a secondary suture of the abdominal wall. This procedure should be reported as 4990078.

79 - Unrelated Procedure by the Same Physician During the Postoperative Period: The physician may need to indicate that the performance of a procedure or service during the postoperative period was unrelated to the original procedure. This circumstance may be reported by using the modifier 79.

A repair of a femoral hernia (49550) is performed on January 5, 1999. The postoperative period designation for this procedure code is 90 days.

On February 12, 1999, the same physician performs an appendectomy. The physician should report the appendectomy as 4495079.

Surgical

50 - Bilateral Procedure: Unless otherwise identified in the listings, bilateral procedures that are performed at the same operative session should be identified by adding themodifier 50to the appropriate five digit code.

Report such procedures as a single line item with a unit of 1. For example, when procedure code 19180 (Mastectomy, simple, complete) is performed bilaterally, report the service as 1918050.

If a procedure is identified by the terminology as bilateral ( or unilateral or bilateral), do NOT report the procedure code with modifier 50. For example, procedure code 68810 to 68815, ( probing of nasolacrimal duct, with or without irrigation, unilateral or bilateral) includes terminology which indicates the procedure is performed either unilaterally or bilaterally. Therefore it's not appropriate to report this modifier with this code.

Additionally some procedure codes, i.e., 52000 (Cystourethroscopy, separate procedure) should NOT be reported with the 50 modifier since anatomy does not permit this procedure to be performed bilaterally.

51 - Multiple Procedures: When multiple procedures, other than evaluation and management services, are performed on the same day or at the same session by the same provider, the primary procedure or service may be reported as listed. The additional procedure(s) or service(s) may be identified by appending the modifier 51 to the additional procedure or service code(s).

Note: This modifier should not be appended to designated "add-on" codes (e.g., 22612, 22614). For more information, please reference chapter 22, section 22.1

53 - Discontinued Procedure: Under certain circumstances, the physician may elect to terminate a surgical or diagnostic procedure. Due to extenuating circumstances or those that threaten the well being of the patient, it may be necessary to indicate that a surgical or diagnostic procedure was started but discontinued. This circumstance may be reported by adding the modifier 53 to the code reported by the physician for the discontinued procedure.

Use modifier 53 (discontinued procedure) to report a failed or terminated colonscopy, or a failed or discontinued procedure. Documentation describing the circumstances requiring the discontinuation of a procedure should be provided with the claim submission. If this information is NOT included, your claim may be denied.

Note: This modifier is not used to report the elective cancellation of a procedure prior to the patient's anesthesia induction and/or surgical preparation in the operating suite. For outpatient hospital/ambulatory surgery center (ASC) reporting of a previously scheduledf procedure/service that is partially reduced or cancelled as a result of extenuating circumstances or those that threaten the well being of the patient prior to or after administration of anesthesia, see modifiers 73 and 74 (see modifiers approved for ASC hospital outpatient use).

54 - Surgical Care Only: When one physician performs a surgical procedure and another provides preoperative and/or postoperative management, surgical services may be identified by adding the modifier 54 to the usual procedure code.

Services billed with a 54 modifier will be reimbursed at the intraoperative allowance for the surgical procedure. The intraoperative allowance includes the one day preoperative care, the intraoperative service, as well as any in-hospital visits that are performed.

55 - Postoperative Management Only: When one physician performs the postoperative management and another physician has performed the surgical procedure, the postoperative component may be identified by adding the modifier 55 to the usual procedure number.

This modifier is used to identify postoperative, out of hospital medical care associated with a given surgical procedure. When billing for postoperative care only, report the original date of surgery as your date of service and the procedure code for the surgical procedure followed by the 55 modifier. In rare situations where the out of hospital postoperative care is split between physicians, each physician must also indicate the period of his/her responsibility for the patient's postoperative care by reporting the appropriate range of dates.

Where a transfer of postoperative care occurs, the receiving physician cannot bill for any part of the global services until he/she has provided at least one service.

62 - Two surgeons: Under certain circumstances the skills of two surgeons (usually with different skills) may be required in the management of a specific surgical procedure. Under such circumstances the separate services may be identified by adding the modifier 62 to the procedure number used by each surgeon for reporting his services.

Under some circumstances the individual skills of two surgeons are required to perform surgery on the same patient during the same operative session. This may be required because of the complex nature of the procedure(s) and /or the patient's condition.

If two surgeons, usually with different skills, are required to perform a single surgical procedure, each surgeon bills for the procedure with modifier 62. Co-surgery also refers to single surgical procedures involving two surgeons performing the parts of the procedure simultaneously, e.g., heart transplant or bilateral knee replacements. Documentation of the medical necessity for two surgeons is required for certain services identified by the Health Care Financing Administration.

66 - Surgical Team: Under some circumstances, highly complex procedures (requiring the concomitant services of several physicians, often of different specialties, plus other highly skilled, specially trained personnel and various types of complex equipment) are carried out under the "surgical team" concept. Such circumstances may be identified by each participating physician with the addition of the modifier 66 to the basic procedure number used for reporting services.

Documentation establishing that a surgical team was medically necessary is required for certain services identified by the Health Care Financing Administration. All claims for team surgeons must contain sufficient information i.e., operative reports, to allow pricing "by report".

73 - Discontinued out-patient hospital/ambulatory surgical center (ASC) procedure prior to the administration of anesthesia: due to extenuating circumstances or those that threaten the well being of the patient, the physician may cancel a surgical or diagnostic procedure subsequent to the patient’s surgical preparation (including sedation when provided, and being taken to the room where the procedre is to be preformed), but prior to the administration of anesthesia (local, regional block(s) or general). Under these circumstances, the intended service that is prepared for but cancelled can be reported by its usual procedure number and the addition of the modifier 73.

Note: The elective cancellation of a service prior to the administration of anesthesia and/or surgical preparation of the patient should not be reported. For physician reporting of a discontinued procedure, see modifier 53.


74 - Discontinued out-patient hospital/ambulatory surgical center (ASC) procedure after administration of anesthesia: due to extenuating circumstances or those that threaten the well being of the patient, the physician may terminate a sugical or diagnostic procedure after the administration of anesthesia (local, regional block(s) or general) or after the procedure was started (incision made, intubation started, scope inserted, etc). Under these circumstances, the procedure started but terminated can be reported by its usual procedure number and the addition of the modifier 74.

Note: The elective cancellation of a service prior to the administration of anesthesia and/or surgical preparation of the patient should not be reported. For physician reporting of a discontinued procedure, see modifier 53.
Discontinued out-patient hospital/ambulatory surgical center (ASC) procedure

80 - Assistant Surgeon: Surgical assistant services may be identified by adding the modifier 80 to the usual procedure number (s).

This modifier should be reported to identify surgical assistant services performed in a non-teaching setting or in a teaching setting when a resident was available but the surgeon opted not to use the resident. In the latter case, the service is generally not covered by Medicare. When the surgical services are performed in a non-teaching setting, report "Non-teaching" in the narrative section of an electronic claim submission, or in Block 24D for paper claims.

Note: Please reference Chapter 22 for more information on assistant surgery reporting requirements.

82 - Assistant Surgeon ( when qualified resident surgeon not available): The unavailability of a qualified resident surgeon is a prerequisite for use of modifier 82 appended to the usual procedure code number (s).

This modifier is used in teaching hospitals if there is no approved training program related to the medical specialty required for the surgical procedure or no qualified resident was available.

Health Professional Shortage Area (HPSA)

These modifiers are used by physicians to indicate the services reported were rendered in a qualified Health Professional Shortage Area (HPSA) and are eligible for the 10% incentive payment.

QB - Physician providing service in a rural HPSA

QU - Physician providing service in an urban HPSA

Additional CPT Modifiers

22 - Unusual Procedural Services: When the service(s) provided is greater than what is usually required for the listed procedure, indicate this by adding modifier 22 to the procedure code. A report is also required.

For services on the physician fee schedule, modifier 22 is applicable only to those procedure codes for which the global surgery concept applies, whether the procedure code is surgical in nature or not. Supportive documentation, e.g., operative reports, progress notes, order sheets, pathology reports, etc., must be submitted with the claim.

Note: Modifier 22 will be removed when reported with procedures that do not have a global surgery period of 0, 10, or 90 days.

26 - Professional Component: Certain procedures are a combination of a physician component and a technical component. When the physician component is reported separately, the service may be identified by adding the modifier 26 to the usual procedure number.

52 - Reduced Services: Under certain circumstances a service or procedure is partially reduced or eliminated at the physician’s discretion. Under these circumstances the service provided can be identified by its usual procedure number and the addition of the modifier -52, signifying that the service is reduced. This provides a means of reporting reduced services without disturbing the identification of the basic service.

Use modifier 52 (reduced service) to indicate a service or procedure is partially reduced or eliminated at the physician’s election. When you report modifier 52, include office records, test results, operative notes, or hospital records to substantiate the reason for reporting a reduced service. If this information is NOT included, your claim may be denied.

Note: Effective January 1, 1999, for hospital outpatient reporting of a previously scheduled procedure/service that is partially reduced or cancelled as a result of extenuating circumstances or those that threaten the well-being of a patient prior to or after administration of anesthesia, see modifiers 73 and 74 (see modifiers approved for ASC hospital outpatient use).

76 - Repeat Procedure by Same Physician: The physician may need to indicate that a procedure or service was repeated subsequent to the original service. This circumstance may be reported by adding the modifier 76 to the repeated service.

Note: When it is medically necessary to repeat a service, the first service should be reported in the usual manner. The repeat service should be reported on the next line with modifier 76 appended to the procedure code. In the event it is medically necessary to repeat a procedure more than twice, report the second line with the 76 modifier and the appropriate number of units in the units field. If a service is repeated more than once, additional documentation should be provided in the narrative field of the claim to support the medical necessity of the repeat services. The patient's medical records must always document the medical necessity of performing repeat procedures and be available to the carrier upon request.

77 - Repeat Procedure by Another Physician: The physician may need to indicate that a basic procedure or service performed by another physician had to be repeated. This situation may be reported by adding modifier 77 to the repeated service.

90 - Reference (Outside) Laboratory: When laboratory procedures are performed by a party other than the treating or reporting physician, the procedure may be identified by adding the modifier 90 to the usual procedure number.

For the Medicare program, this modifier is used by independent clinical laboratories when referring tests to a reference laboratory for analysis.

91 - Repeat clinical diagnostic laboratory test: In the same course of treatment of the patient, it may be necessary to repeat the same laboratory test on the same day to obtain subsequent (multiple) test results. Under these circumstances, the laboratory test performed can be identified by its usual procedure number and the addition of the modifier 91.

Note: This modifier may not be used when tests are rerun to confirm initial results; due to testing problems with specimens or equipment; or for any other reason when a normal, one-time, reportable result is all that is required.

This modifier may not be used when other code(s) describe a series of test results (e.g., glucose tolerance tests, evocative/suppression testing). This modifier may only be used for laboratory test(s) performed more than once on the same day on the same patient. (Note: Effective for dates of service 1/1/2000 and after.)

99 - Multiple Modifiers: Under certain circumstances two or more modifiers may be necessary to completely delineate a service. In such situations, modifier 99 should be added to the basic procedure and other applicable modifiers may be listed as part of the description of the service.

Note: This modifier should be used by providers submitting claims electronically when it is necessary to report more than two modifiers. In this situation, other applicable modifiers should be reported in the narrative portion of the electronic claim.

Additional HCPCS Modifiers

AH - Clinical Psychologist

AJ - Clinical Social Worker

AM - Physician, team member service

EJ - Subsequent claims for a defined course of therapy, e.g., EPO, Sodium Hyaluronate, Infliximab.

E1 - Upper left, eyelid

E2 - Lower left, eyelid

E3 - Upper right, eyelid

E4 - Lower right, eyelid

Note: These modifiers can be used to specify on which eyelid services were performed. Comprehensive and component code combinations performed on different eyelids are seperately payable.

FA - Left Hand, thumb

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

Note: These modifiers can be used to indicate that rebundled services were performed on different digits. Seperate payment will be allowed when column I & II services are performed on different digits. See Appendix C for comprehensive and component code combinations.

G6 - ESRD patient for whom less than six dialysis sessions have been provided in a month

G7 - Pregnancy resulted from rape or incest or pregnancy certified by physicians as life threatening

GA - Beneficiary authorization

Effective for dates of service on and after October 1, 1995, report this modifier to indicate that advance written notice was provided to the beneficiary of the likelihood of denial of a service as being not reasonable and necessary under Medicare guidelines. See chapter 6, page 6-6.1 for example of written notice.

GC - This service has been performed in part by a resident under the direction of a teaching physician.

GE - This service has been performed by a resident without the presence of a teaching physician under the primary care exception.

Note: GE, for this purpose, is for use on all services except ambulance.

GH - Diagnostic mammogram converted from screening mammogram on the same day

GN - Service delivered personally by a speech-language pathologist or under an outpatient speech-language pathology plan of care

GO - Service delivered personally by an occupational therapist or under an outpatient occupational therapy plan of care

GP - Service delivered personally by a physical therapist or under an outpatient physical therapy plan of care

GT - Via interactive audio and video telecommunication systems

GX - Service not covered by Medicare

Note:
Effective January 1, 1999, when a beneficiary refuses to have an x-ray, the claim must be billed using the correct chiropractic HCPCS code (98940, 89841, or 98942) along with the new GX modifier.

QA: - FDA investigational device exemption. FDA-approved investigational devices and/or services incident to the use of such devices should be billed using the appropriate HCPCS code and the QA modifier. When billing a service with the QA modifier, you are certifying FDA approval of a clinical trial for the device and that the device was approved at the time the service was rendered.

The FDA will issue an investigational device exemption (IDE) number that corresponds to each FDA-approved device that has been granted an investigational device exemption.

Providers must obtain the investigational device exemption number from the manufacturer supplying the device in the clinical trial.

LT - Left side (used to identify procedures performed on the left side of the body)

If used to substantiate different body sites, this modifier can exclude services from rebundling.

Q1 - Documentation on file for ambulatory or nonambulatory patients that indicates mycosis/dystrophy of the toenail causing secondary infection and/or pain which results or would result in marked limitation of ambulation and require the professional skills of a provider.

Note: This modifier is applied to ambulatory as well as non-ambulatory patients. Documentation that these conditions exist must be maintained in the patient's file.

Q3 - Live kidney donor: services associated with postoperative medical complications directly related to the donation.

This modifier is effective for services furnished on or after January 1, 1995.

These postoperative services will be reimbursed at 100% of the allowed charge as required in Section 1881 (d) of the Social Security Act.

The following bullets are some reporting notes and tips for submitting kidney donor services:

Q4 - Service for ordering/referring physician qualifies as a service exemption for laboratory services

Q5 - Service furnished by a substitute physician under a reciprocal billing arrangement

Q6 - Service furnished by a locum tenens physician

Q7 - One Class A Finding

Q8 - Two Class B Findings

Q9 - One Class B and Two Class C Findings

Note: Modifiers Q7, Q8, and Q9 are effective for dates of service on and after October 1, 1995 and are to be used to bill podiatric services.

QP: - Documentation is on file showing that the lab test(s) was ordered individually or ordered as a CPT-recognized panel other than automated profile codes 80002-80019, G0058, G0059 and G0060.

QR - Repeat clinical diagnostic laboratory test performed on the same day to obtain subsequent reportable test value(s) (separate specimens taken in separate encounters.) (This modifier should not be used for dates of service after 12/31/1999. See modifier -91.)

QW - CLIA Waived Tests (Please reference appendix Ha for additional information.)

QY - Medical Direction of one certified registered nurse anesthetist (CRNA) by an anesthesiologist.

RT - Right side (used to identify procedures performed on the right side of the body)

If used to substantiate different body sites, this modifier can exclude services from rebundling.

SF - Second opinion ordered by a Professional Review Organization (PRO) per section 9401, P.L. 99-272 (100 % reimbursement - no Medicare deductible or coinsurance)

SG - Ambulatory surgical center (ASC) facility service

This modifier is only used by the ASC for identifying the facility charge. It should not be reported by the physician when reporting his/her professional service rendered in an ASC.

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

Note: These modifiers can be used to indicate that comprehensive or component code combinations were performed on different digits. Separate payment will be allowed when column I & II services are performed on different digits. See Appendix C (New Correct Coding Combinations).

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 code number.

W7 - Kidney Donor (see modifier Q3 for more information)

XJ - Course of treatment has ended (radiation therapy) This modifier is used to indicate the course of treatment for radiation therapy has ended. If this modifier is not reported, additional fractions will be denied.

YR - Services performed by another provider but billed as services performed "incident to" the personal professional services of the billing physician/non-physician.

Beginning January 1, 1997, services provided `incident to' the personal professional services of a physician/non-physician must be billed using the YR modifier. The YR modifier is intended to be attached to all personal professional services performed `incident to' which may be identified by a CPT or HCPCS level I or II code. In general, `incident to' services are services performed by a physician's or non-physician provider's employee, but reported on the claim as if the billing physician or non-physician provider has provided the service.

YY - Second surgical opinion (See modifier SF for PRO-ordered services)

ZD - Routine non-covered services

Services reported with this modifier will be denied as non-covered.

ZP - No purchased services (*) DO NOT REPORT THIS MODIFIER
* Effective with claims received on or after June 23, 1998, do not report the ZP modifier with diagnostic service. If the technical portion of the diagnostic services was NOT purchased block 20 (or electronic equivalent) should be checked “NO”. If the technical portion of the diagnostic service was purchased, blocks 20 and 32 of the HCFA 1500 claim form (or electronic equivalent) must be completed to meet purchased service criteria.

ZX - Medical necessity for portable Xray suppliers and independent physiological laboratories DO NOT REPORT THIS MODIFIER
Note: Providers/Suppliers are required to maintain medical necessity documentation on file.

ZZ - Third surgical opinion.