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Appendix A
Modifiers
This list includes all of the modifiers applicable to CPT 2001 codes.
-21 Prolonged Evaluation and Management Services: When the face-to-face or
floor/unit service(s) provided is prolonged or otherwise greater than that
usually required for the highest level of evaluation and management service
within a given category, it may be identified by adding modifier '-21' to the
evaluation and management code number or by use of the separate five digit
modifier code 09921. A report may also be appropriate.

-22 Unusual Procedural Services: When the service(s) provided is greater than
that usually required for the listed procedure, it may be identified by adding
modifier '-22' to the usual procedure number or by use of the separate five
digit modifier code 09922. A report may also be appropriate. Note: This modifier
is not to be used to report procedure(s) complicated by adhesion formation,
scarring, and/or alteration of normal landmarks due to late effects of prior
surgery, irradiation, infection, very low weight (ie, neonates and infants less
than 10 kg) or trauma. (See modifier '-60', as appropriate.)

-23 Unusual Anesthesia: Occasionally, a procedure, which usually requires either
no anesthesia or local anesthesia, because of unusual circumstances must be done
under general anesthesia. This circumstance may be reported by adding the
modifier '-23' to the procedure code of the basic service or by use of the
separate five digit modifier code 09923.

-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, or the separate five
digit modifier 09924 may be used.

-25 Significant, Separately Identifiable Evaluation and Management Service by
the Same Physician on the Same Day of the Procedure or Other Service: 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 other service provided
or beyond the usual preoperative and postoperative care associated with the
procedure that was performed. The E/M service 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 the 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, or the separate five digit modifier 09925 may
be used. Note: This modifier is not used to report an E/M service that resulted
in a decision to perform surgery. See modifier '-57.'

-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 or the service may be reported by use of the five digit
modifier code 09926.

-32 Mandated Services: Services related to mandated consultation and/or related
services (eg, PRO, third party payer, governmental, legislative or regulatory
requirement) may be identified by adding the modifier '-32' to the basic
procedure or the service may be reported by use of the five digit modifier
09932.

-47 Anesthesia by Surgeon: Regional or general anesthesia provided by the
surgeon may be reported by adding the modifier '-47' to the basic service or by
use of the separate five digit modifier code 09947. (This does not include local
anesthesia.) Note: Modifier '-47' or 09947 would not be used as a modifier for
the anesthesia procedures 00100-01999.

-50 Bilateral Procedure: Unless otherwise identified in the listings, bilateral
procedures that are performed at the same operative session should be identified
by adding the modifier '-50' to the appropriate five digit code or by use of the
separate five digit modifier code 09950.

-51 Multiple Procedures: When multiple procedures, other than Evaluation and
Manage ment Services, are performed 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) or by the use of the separate five
digit modifier 09951. Note: This modifier should not be appended to designated
"add-on" codes (see Appendix E).

-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. Modifier code 09952 may be used as an
alternative to modifier '-52.' Note: 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
the patient prior to or after administration of anesthesia, see modifiers '-73'
and '-74' (see modifiers approved for ASC hospital outpatient use).

-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 or by use of
the separate five digit modifier code 09953. 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
scheduled 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 number or
by use of the separate five digit modifier code 09954.

-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 or by use of the separate five digit modifier code 09955.

-56 Preoperative Management Only: When one physician performs the preoperative
care and evaluation and another physician performs the surgical procedure, the
preoperative component may be identified by adding the modifier '-56' to the
usual procedure number or by use of the separate five digit modifier code 09956.

-57 Decision for Surgery: An evaluation and management service that resulted in
the initial decision to perform the surgery may be identified by adding the
modifier '-57' to the appropriate level of E/M service, or the separate five
digit modifier 09957 may be used.

-58 Staged or Related 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: a) planned
prospectively at the time of the original procedure (staged); b) more extensive
than the original procedure; or c) for therapy following a diagnostic surgical
procedure. This circumstance may be reported by adding the modifier '-58' to the
staged or related procedure, or the separate five digit modifier 09958 may be
used. Note: This modifier is not used to report the treatment of a problem that
requires a return to the operating room. See modifier '-78.'

-59 Distinct Procedural Service: Under certain circumstances, the physician may
need to indicate that a procedure or service was distinct or independent from
other services performed on the same day. Modifier '-59' is used to identify
procedures/services that are not normally reported together, but are appropriate
under the circumstances. This may represent a different session or patient
encounter, different procedure or surgery, different site or organ system,
separate incision/excision, separate lesion, or separate injury (or area of
injury in extensive injuries) not ordinarily encountered or performed on the
same day by the same physician. However, when another already established
modifier is appropriate it should be used rather than modifier '-59.' Only if no
more descriptive modifier is available, and the use of modifier '-59' best
explains the circumstances, should modifier '-59' be used. Modifier code 09959
may be used as an alternative to modifier '-59.'

-60 Altered Surgical Field: Certain procedures involve significantly increased
operative complexity and/or time in a significantly altered surgical field
resulting from the effects of prior surgery, marked scarring, adhesions,
inflammation, or distorted anatomy, irradiation, infection, very low weight (ie,
neonates and small infants less than 10 kg) and/or trauma (as documented in the
patient's medical record). These circumstances should be reported by adding the
modifier '-60' to the procedure number or by use of the separate five digit
modifier code 09960. Note: For unusual procedural services not involving an
altered surgical field due to the late effects of previous surgery, irradiation,
infection, very low weight (ie, neonates and infants less than 10 kg) and/or
trauma, append the modifier '-22' or use the separate five-digit code 09922.

-62 Two Surgeons: When two surgeons work together as primary surgeons performing
distinct part(s) of a single reportable procedure, each surgeon should report
his/her distinct operative work by adding the modifier '-62' to the single
definitive procedure code. Each surgeon should report the co-surgery once using
the same procedure code. If additional procedure(s) (including add-on
procedure(s)) are performed during the same surgical session, separate code(s)
may be reported without the modifier '-62' added. Modifier code 09962 may be
used as an alternative to modifier '-62'. Note: If a co-surgeon acts as an
assistant in the performance of additional procedure(s) during the same surgical
session, those services may be reported using separate procedure code(s) with
the modifier '-80' or modifier '-81' added, as appropriate.

-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, 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. Modifier code 09966 may be used as an alternative to modifier '-66.'

-76 Repeat Procedure by Same Physician: The physician may need to indicate that
a procedure or service was repeated subsequent to the original procedure or
service. This circumstance may be reported by adding the modifier '-76' to the
repeated procedure/service or the separate five digit modifier code 09976 may be
used.

-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 procedure/service or the separate five digit modifier code 09977 may be
used.

-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 modifier '-78' to the related
procedure, or by using the separate five digit modifier 09978. (For repeat
procedures on the same day, see '-76'.)

-79 Unrelated 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 unrelated to the
original procedure. This circumstance may be reported by using the modifier 
'-79' or by using the separate five digit modifier 09979. (For repeat procedures
on the same day, see '-76'.)

-80 Assistant Surgeon: Surgical assistant services may be identified by adding
the modifier '-80' to the usual procedure number(s) or by use of the separate
five digit modifier code 09980.

-81 Minimum Assistant Surgeon: Minimum surgical assistant services are
identified by adding the modifier '-81' to the usual procedure number or by use
of the separate five digit modifier code 09981.

-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) or by use of the
separate five digit modifier code 09982.

-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 or by use
of the separate five digit modifier code 09990.

-91 Repeat Clinical Diagnostic Laboratory Test: In the 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 (eg, 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.

-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. Modifier code 09999 may be
used as an alternative to modifier '-99.'

Modifiers Approved for Ambulatory Surgery Center (ASC) Hospital Outpatient Use
CPT Level I Modifiers
(Modifiers -25, -58, -78, and -79 are also approved effective 8/00.)

-27 ultiple Outpatient Hospital E/M Encounters on the Same Date: For hospital
outpatient reporting purposes, utilization of hospital resources related to
separate and distinct E/M encounters performed in multiple outpatient hospital
settings on the same date may be reported by adding the modifier '-27' to each
appropriate level outpatient and/or emergency department E/M code(s). This
modifier provides a means of reporting circumstances involving evaluation and
management services provided by physician(s) in more than one (multiple)
outpatient hospital setting(s) (eg, hospital emergency department, clinic).
Note: This modifier is not to be used for physician reporting of multiple E/M
services performed by the same physician on the same date. For physician
reporting of all outpatient evaluation and management services provided by the
same physician on the same date and performed in multiple outpatient setting(s)
(eg, hospital emergency department, clinic), see Evaluation and Management,
Emergency Department, or Preventive Medicine Services codes.

-50 Bilateral Procedure: Unless otherwise identified in the listings, bilateral
procedures that are performed at the same operative session should be identified
by adding the modifier '-50' to the appropriate five digit code or by use of the
separate five digit modifier code 09950.

-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. Modifier code 09952 may be used as an
alternative to modifier '-52.' Note: 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
the patient prior to or after administration of anesthesia, see modifiers '-73'
and '-74' (see modifiers approved for ASC hospital outpatient use).

-59 Distinct Procedural Service: Under certain circumstances, the physician may
need to indicate that a procedure or service was distinct or independent from
other services performed on the same day. Modifier '-59' is used to identify
procedures/services that are not normally reported together, but are appropriate
under the circumstances. This may represent a different session or patient
encounter, different procedure or surgery, different site or organ system,
separate incision/excision, separate lesion, or separate injury (or area of
injury in extensive injuries) not ordinarily encountered or performed on the
same day by the same physician. However, when another already established
modifier is appropriate it should be used rather than modifier '-59.' Only if no
more descriptive modifier is available, and the use of modifier '-59' best
explains the circumstances, should modifier '-59' be used. Modifier code 09959
may be used as an alternative to modifier '-59.'

-73 Discontinued Out-Patient Hospital/Ambulatory Surgery 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 procedure is to be performed), 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' or by use of the
separate five digit modifier code 09973. 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 Surgery 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
surgical or diagnostic procedure after the administration of anesthesia (local,
regional block(s), 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' or by use of the separate five digit
modifier code 09974. 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.'

-76 Repeat Procedure by Same Physician: The physician may need to indicate that
a procedure or service was repeated subsequent to the original procedure or
service. This circumstance may be reported by adding the modifier '-76' to the
repeated procedure/service or the separate five digit modifier code 09976 may be
used.

-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 procedure/service or the separate five digit modifier code 09977 may be
used.

-91 Repeat Clinical Diagnostic Laboratory Test: In the 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 (eg, 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.

Level II (HCPCS/National) Modifiers
-E1 Upper left, eyelid
-E2 Lower left, eyelid
-E3 Upper right, eyelid
-E4 Lower right, eyelid
-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
-FA Left hand, thumb
-LC Left circumflex coronary artery (Hospitals use with codes 92980-92984,
 92995, 92996)
-LD Left anterior descending coronary artery (Hospitals use with codes 92980-
92984, 92995, 92996)
-LT Left side (used to identify procedures performed on the left side of the
 body)
-QM Ambulance service provided under arrangement by a provider of services
-QN Ambulance service furnished directly by a provider of services
-QR Repeat laboratory test performed on the same day
-RC Right coronary artery (Hospitals use with codes 92980-92984, 92995, 92996)
-RT Right side (used to identify procedures performed on the right side of the
 body)
-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
-TA Left foot, great toe


