modif app

Modifiers: Approved List

Below is a list of approved modifier codes for use in billing Medi-Cal. Modifiers not listed in this section
are unacceptable for billing Medi-Cal.

Modifier Overview

Some modifier information in this section is taken from the CPT-4

code book (Current Procedural Terminology 4th Edition) and
HCPCS code book (Healthcare Common Procedure Coding System,
Level II).

Discontinued Modifiers

Medicaid programs have traditionally tailored modifiers for their states

needs. This interim (or local) series of modifiers is being phased out
under HIPAA requirements. Refer to the list of discontinued and
invalid modifiers at the end of this section.

Approved
Modifier

National Modifier Description

8A

CFTR (cystic fibrosis)

22*

Increased procedural services

Program-Specific Use of the Modifier and

Special Considerations
This modifier is only used for prenatal
screening of cystic fibrosis.
May be used with computerized tomography
(CT) codes when additional slices are required
or a more detailed evaluation is necessary.
Used by Local Educational Agency (LEA) to
denote an additional 15-minute service
increment rendered beyond the required initial
service time. See Local Educational Agency
(LEA) in the appropriate Part 2 manual for more
information.
Surgical: May be billed when 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 (for example,
neonates and small infants less than 10 kg)
and/or trauma (as documented in a recipients
medical record). Justification is required on the
claim.

24*

Unrelated E&M service by the

same physician during a
postoperative period

25*

Significant, separately
identifiable E&M service by the
same physician on the same
day of the procedure or other
service

* Check the CPT-4 book for guidelines.

2 Modifiers: Approved List
August 2009

modif app

2
Approved
Modifier

National Modifier Description

26*

Professional component

47*

Anesthesia by surgeon

50*

Bilateral procedure

51*

Multiple procedures

52*

Reduced services

Program-Specific Use of the Modifier and

Special Considerations

Do not use as a modifier for anesthesia codes.

Surgical: For use with surgery codes

66820 66821, 66830, 66840, 66850, 66920,
66930, 66940 and 66982 66985. Requires By
Report documentation.
Used by LEA to denote an annual
re-assessment. See Local Educational
Agency (LEA) in the appropriate Part 2 manual
for more information. LEA does not require
By Report documentation.

53*

Discontinued procedure

Requires By Report documentation.

54*

Surgical care only

Surgical: Use only with surgery codes

66820 66821, 66830, 66840, 66850, 66920,
66930, 66940 and 66982 66985. Requires By
Report documentation.

55*

Postoperative management
only

58*

Staged or related procedure

or service by the same
physician during the
postoperative period

May be used with codes 15002 15431 and

52601 to address subsequent part(s) of a
staged procedure.

59*

Distinct procedural service

Use only with codes 36818 36819 and

76816.

62*

Two surgeons

66*

Surgical team

73

Discontinued outpatient
hospital/ambulatory surgery
center (ASC) procedure prior to
the administration of anesthesia
(to be reported by hospital
outpatient department or
surgical clinic, only)

To be reported by hospital outpatient

department or surgical clinic only. Requires
By Report documentation.

74

Discontinued outpatient
hospital/ambulatory surgery
center (ASC) procedure after
administration of anesthesia

To be reported by hospital outpatient

department or surgical clinic only. Requires
By Report documentation.

* Check the CPT-4 book for guidelines.

2 Modifiers: Approved List
August 2009

modif app

3
Approved
Modifier

National Modifier Description

Program-Specific Use of the Modifier and

Special Considerations

76*

Repeat procedure or service

by same physician

77*

Repeat procedure by another

physician

78*

Unplanned return to the

operating/procedure room by
the same physician following
initial procedure for a related
procedure during the
postoperative period

79*

Unrelated procedure or service

by the same physician during
the postoperative period

80*

Assistant surgeon

90*

Reference (outside) laboratory

Only specified providers may use this modifier.

99*

Multiple modifiers

Used when two or more modifiers are

necessary to completely delineate a service;
the multiple modifiers used must be explained
in the Remarks field (Box 80)/Reserved for
Local Use field (Box 19) of the claim.
Also used in special circumstances as specified
by the Department of Health Care Services
(DHCS). For an example, refer to the Surgery
Billing Examples: UB-04 or Surgery Billing
Examples: CMS-1500 sections in the
appropriate Part 2 manual.

AG

Primary physician

Surgical: Used to denote a primary surgeon. In the

case of multiple primary surgeons, two or more
surgeons can use modifier AG for the same
patient on the same date of service if the
procedures are performed independently and in
different specialty areas.
This does not include surgical teams or surgeons
performing a single procedure requiring different
skills. An explanation of the clinical situation and
operative reports by all surgeons involved must
be included with the claim.
Used by LEA to denote licensed
physicians/psychiatrists. See Local
Educational Agency (LEA) in the
appropriate Part 2 manual for more
information.

* Check the CPT-4 book for guidelines.

2 Modifiers: Approved List
April 2009

modif app

4
Approved
Modifier

National Modifier Description

Program-Specific Use of the Modifier and

Special Considerations

AH

Clinical psychologist

Used by LEA to denote licensed psychologists,

licensed educational psychologists and
credentialed school psychologists. See Local
Educational Agency (LEA) in the
appropriate Part 2 manual for more
information.

AJ

Clinical social worker

Used by LEA to denote licensed clinical social

workers and credentialed school social
workers. See Local Educational Agency
(LEA) in the appropriate Part 2 manual for
more information.

AP

Determination of refractive
state was not performed in the
course of diagnostic
ophthalmological
examination

Use only for ophthalmology.

E1

Upper left, eyelid

Use modifier SC with CPT-4 code 68761

(closure of lacrimal punctum; by
thermocauterization, ligation, or laser
surgery; by plug, each) to indicate use of
temporary collagen punctal plugs.
Modifiers E1 thru E4 are reserved for
permanent silicone punctal plugs.

E2

Lower left, eyelid

Same as above

E3

Upper right, eyelid

Same as above

E4

Lower right, eyelid

Same as above

ET

Emergency services

GN

Service delivered under an

outpatient speech-language
pathology plan of care

Used by LEA to denote licensed speech-language

pathologists and speech-language pathologists.
See Local Educational Agency (LEA) in the
appropriate Part 2 manual for more
information.

GO

Service delivered under an

outpatient occupational
therapy plan of care

Used by LEA to denote registered occupational

therapists. See Local Educational Agency
(LEA) in the appropriate Part 2 manual for
more information.

GP

Service delivered under an

outpatient physical therapy
plan of care

Used by LEA to denote licensed physical

therapists. See Local Educational Agency
(LEA) in the appropriate Part 2 manual for
more information.

GQ

Via asynchronous
telecommunications system

Used to denote store-and-forward

telecommunications system.

* Check the CPT-4 book for guidelines.

2 Modifiers: Approved List
April 2009

modif app

5
Approved
Modifier

National Modifier Description

Program-Specific Use of the Modifier and

Special Considerations

GT

Via interactive audio and video

telecommunications sytems

Used to denote real-time telecommunications

system.

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.

Used to denote that the recipient has started a

physician-ordered course of treatment before
reaching 21 years of age and the recipient is to
complete the course of the prescribed
treatment; OR the recipient started a
physician-ordered course of treatment before
July 1, 2009 and required additional time to
complete treatment after this date. GY is to be
used ONLY for services exempted from the
optional benefits exclusion policy.
Use of GY only applies to medical/surgical care
required for the treatment and the resolution of
the acute episode.

HA

Child/adolescent program

Used by pediatric subacute facility to denote

that the patient is a child.

HB

Adult program, nongeriatric

Used by adult subacute facility to denote that

the patient is an adult.

HO

Masters degree level

Used by LEA to denote program specialists.

See Local Educational Agency (LEA) in the
appropriate Part 2 manual for more information.

KC

Replacement of special power

wheelchair interface

KX

Requirements specified in the

medical policy have been met

LT

Left side (used to identify

procedures performed on the
left side of the body)

NU

New equipment

Used to denote purchase of new equipment.

P1*

A normal, healthy patient

Used to denote anesthesia services provided to

a normal, uncomplicated patient.

P3*

A patient with severe systemic

disease

Used to denote anesthesia services provided to

a patient with severe systemic disease.

P4*

A patient with severe systemic

disease that is a constant
threat to life

Used to denote anesthesia services provided to

a patient with severe systemic disease that is a
constant threat to life.

P5*

A moribund patient who is not

expected to survive without the
operation

Used to denote anesthesia services provided to

a moribund patient who is not expected to
survive without the operation.

Specific required documentation on file.

* Check the CPT-4 book for guidelines.

2 Modifiers: Approved List
July 2009

modif app

6
Approved
Modifier

National Modifier Description

Program-Specific Use of the Modifier and

Special Considerations

QE

Prescribed amount of oxygen is

less than one liter per minute
(LPM)

QF

Prescribed amount of oxygen

exceeds four liters per minute
(LPM) and portable oxygen is
prescribed

QG

Prescribed amount of oxygen is

greater than four liters per
minute (LPM)

Use this modifier if portable oxygen is NOT

prescribed.

QS

Monitored anesthesia care

service

Used by California Childrens Services (CCS) to

denote monitored anesthesia care.

QW

CLIA waived test

RA

Replacement

RB

Replacement as part of a
repair

Used to certify that the provider is performing

testing for the procedure with the use of a
specific test kit from manufacturers identified by
the Centers for Medicare & Medicaid Services
(CMS).
Used to indicate replacement vision care
frames and lenses
Used to indicate replacement parts during
repair of Durable Medical Equipment (DME),
repair, including parts of eyeglass frames.

RR

Rental

RT

Right side (used to identify

procedures performed on the
right side of the body)

SA

Nurse practitioner rendering

service in collaboration with a
physician

SB

Nurse midwife

SC

Medically necessary service or

supply

SK

Member of high-risk population

(use only with codes for
immunization)

SL

State-supplied vaccine

Used to indicate when DME is to be rented.

Used for Vaccines For Children (VFC) program

recipients younger than 18 years of age.

* Check the CPT-4 book for guidelines.

2 Modifiers: Approved List
August 2009

modif app

7
Approved
Modifier

National Modifier Description

TC

Technical component

TD

Registered nurse (RN)

TE

Licensed practical nurse

(LPN)/Licensed vocational
nurse (LVN)

Program-Specific Use of the Modifier and Special

Considerations

Used by LEA to denote licensed vocational

nurses. See Local Educational Agency (LEA) in
the appropriate Part 2 manual for more
information.
Used by Pediatric Palliative Care Waiver
Program (PPCWP) to denote licensed
vocational nurses providing services to children
receiving palliative care services.

TH

Obstetrical
treatment/services, prenatal
or postpartum

Used to denote that the service rendered is

ONLY for pregnancy-related services and
services for the treatment of other
conditions that might complicate the
pregnancy. Modifier TH can be used for up
to 60 days after termination of pregnancy.
TH is to be used ONLY for services
exempted from the optional benefits
exclusion policy.

TL

Early intervention/
Individualized Family Services
Plan (IFSP)

Used by LEA to denote that service is part of

IFSP. See Local Educational Agency (LEA) in
the appropriate Part 2 manual for more
information.

TM

Individualized Education Plan

(IEP)

Used by LEA to denote that service is part of

individualized education plan. See Local
Educational Agency (LEA) in the appropriate
Part 2 manual for more information.

TS

Follow-up service

TT

Individualized service provided

to more than one patient in
same setting

Used by LEA to denote an amended

re-assessment. See Local Educational Agency
(LEA) in the appropriate Part 2 manual for more
information.
Used by HCBS Waiver Program to denote
services provided to two HCBS NF/AH Waiver
recipients who reside in the same residence.
Also referred to as shared services.

U1

Medicaid level of care 1, as

defined by each state

Used by HCBS Waiver Program to denote

skilled nursing services A or B level of care.

U2

Medicaid level of care 2, as

defined by each state

Used by HCBS Waiver Program to denote

subacute level of care.

U3

Medicaid level of care 3, as

defined by each state

Used by HCBS Waiver Program to denote

acute level of care.

* Check the CPT-4 book for guidelines.

2 Modifiers: Approved List
June 2009

modif app

8
Approved
Modifier

National Modifier Description

Program-Specific Use of the Modifier and Special

Considerations

U7

Medicaid level of care 7, as

defined by each state

Used to denote services rendered by Physician

Assistant (PA).

UD

Medicaid level of care 13, as

defined by each state

Used by Section 340B providers to denote

services provided or drugs purchased under
this program.

UJ

Services provided at night

UN

Two patients served

UP

Three patients served

UQ

Four patients served

UR

Five patients served

US

Six or more patients served

YW

Not applicable. This is an interim

(local) modifer.

Required professional experience (applies only

to speech therapists and audiologists)

Z1

Not applicable. This is an interim

(local) modifer.

Additional air mileage in excess of 10 percent of

standard airway mileage distances. Reason for
additional mileage flown must be documented
on the claim or on an attachment.

ZA

Not applicable. This is an interim

(local) modifer.

Anesthesia procedures complicated by position

or surgical field avoidance

ZB

Not applicable. This is an interim

(local) modifer.

Anesthesia (emergency services, healthy

patient)

ZC

Not applicable. This is an interim

(local) modifer.

Anesthesia complicated by extracorporeal

circulation

ZD

Not applicable. This is an interim

(local) modifer.

Emergency anesthesia (systemic disease)

ZE

Not applicable. This is an interim

(local) modifer.

Nurse Anesthetist service; elective anesthesia:

normal, healthy patient

ZF

Not applicable. This is an interim

(local) modifer.

Anesthesia supervision

ZG

Not applicable. This is an interim

(local) modifer.

Multiple anesthesia modifiers

ZH

Not applicable. This is an interim

(local) modifer.

Nurse Anesthetist service; anesthesia special

circumstances: unusual position/field
avoidance

* Check the CPT-4 book for guidelines.

2 Modifiers: Approved List
June 2009

modif app

9
Approved
Modifier

National Modifier Description

Program-Specific Use of the Modifier and Special

Considerations

ZI

Not applicable. This is an interim

(local) modifer.

Nurse Anesthetist service; anesthesia special

circumstances: total body hypothermia

ZJ

Not applicable. This is an interim

(local) modifer.

Nurse Anesthetist service; emergency

anesthesia: normal, healthy patient

ZL

Not applicable. This is an interim

(local) modifer.

This modifier is used to certify that initial

comprehensive antepartum office visit occurred
within 16 weeks of the last menstrual period
(LMP) (up to and including pregnancies of 16
weeks and 0/7ths days gestation only). Used
with HCPCS code Z1032 only. (Reimbursed
only once during pregnancy service limitation
of once in nine months.)
Use of this modifier adds $56.63 to
reimbursement. Available only to
Comprehensive Perinatal Services Program
(CPSP) providers. For enrollment information,
see Pregnancy: Comprehensive Perinatal
Services Program (CPSP) in the appropriate
Part 2 manual.

ZM

Not applicable. This is an interim

(local) modifer.

Supplies and drugs for surgical procedures with

other than general anesthesia or no anesthesia

ZN

Not applicable. This is an interim

(local) modifer.

Supplies and drugs for surgical procedures with

general anesthesia

ZO

Not applicable. This is an interim

(local) modifer.

Nurse Anesthetist service; anesthesia special

circumstances: extracorporeal circulation

ZP

Not applicable. This is an interim

(local) modifer.

Nurse Anesthetist service; elective anesthesia:

patient with severe systemic disease that is a
constant threat to life

ZQ

Not applicable. This is an interim

(local) modifer.

Family planning counseling. Certifies that

family planning counseling was provided during
a routine non-family planning office visit.
Limited to female recipients 15 44 years of
age. Can be reimbursed once per recipient per
provider in a 12-month period. (For detailed
billing information, see Family Planning in the
appropriate Part 2 manual.)

ZR

Not applicable. This is an interim

(local) modifer.

Nurse Anesthetist service; emergency

anesthesia: patient with severe systemic
disease that is a constant threat to life

* Check the CPT-4 book for guidelines.

2 Modifiers: Approved List
June 2009

modif app

10
Approved
Modifier

National Modifier Description

Program-Specific Use of the Modifier and Special

Considerations

ZS

Not applicable. This is an interim

(local) modifer.

Professional and technical component

ZT

Not applicable. This is an interim

(local) modifer.

Nurse Anesthetist service; emergency

anesthesia: moribund patient who is not
expected to survive without the operation

ZX

Not applicable. This is an interim

(local) modifer.

Nurse Anesthetist service; emergency or

elective anesthesia: patient with severe
systemic disease

ZY

Not applicable. This is an interim

(local) modifer.

Nurse Anesthetist service; elective anesthesia:

moribund patient who is not expected to survive
without the operation

* Check the CPT-4 book for guidelines.

2 Modifiers: Approved List
June 2009

modif app

11
Discontinued and Invalid Modifiers
Below is a list of discontinued and invalid modifier codes for use in billing Medi-Cal. Modifiers listed
below are no longer acceptable for billing Medi-Cal.
Discontinued/
Invalid Modifier

Discontinuation
Date

21

September 1, 2009

60

May 1, 2009

75

May 1, 2009

Concurrent care, services rendered by more than one

physician

AF

August 1, 2005

Anesthesia complicated by total body hypothermia

above 30 degrees

AG

August 1, 2005

Emergency anesthesia (moribund patient)

AN

February 1, 2009

Physician assistant service. Replaced by HIPAA

compliant modifier U7.

AS

February 1, 2009

Physician Assistant serving as first assistant in

surgery under an approved supervising physician.
Use HIPAA compliant modifier 80 to denote
assistant surgeon.

Y1

November 1, 2005

Rental without sales tax (hearing aids)

Y2

November 1, 2005

Purchase or repair without sales tax (hearing aids)

Y6

November 1, 2005

Rental with sales tax (hearing aids)

Y7

November 1, 2005

Purchase, repair, mileage with sales tax

(standard item, hearing aids)

YQ

November 1, 2005

Certified Nurse Midwife service (when billed by a

physician, organized outpatient clinic or hospital
outpatient department). Replaced by HIPAA
compliant modifier SB.

YR

February 1, 2009

Certified Nurse Midwife service (multiple

modifiers) (when billed by a physician, organized
outpatient clinic or hospital outpatient
department). Replaced by HIPAA compliant
modifier 99.

YS

November 1, 2005

Nurse Practitioner service. Replaced by HIPAA

compliant modifier SA.

YT

February 1, 2009

Nurse Practitioner service (multiple modifiers).

Replaced by HIPAA compliant modifier 99.

YU

February 1, 2009

Physician Assistant service (multiple modifiers).

Replaced by HIPAA compliant modifier 99.

YV

July 1, 2001

AIDS Waiver providers only. Administrative expenses

when billed by Computer Media Claims (CMC).

Modifier Description
Prolonged evaluation and management services
(see Evaluation and Management [E&M] section in
the appropriate provider manual on how to bill for
prolonged E&M visits)
Altered surgical field. Use modifier 22.

* Check the CPT-4 book for guidelines.

2 Modifiers: Approved List
August 2009

modif app

12
Discontinued/
Invalid Modifier

Discontinuation
Date

ZK

November 1, 2005

Primary Surgeon. Replaced by HIPAA compliant

modifier AG

ZU

November 1, 2005

Exception modifier to 80 percent reimbursement

(medical necessity requires common office
procedure to be performed in outpatient setting)

ZV

November 1, 2005

Exception modifier to 80 percent reimbursement

(non-hospital-compensated physician called from
outside to render emergency service)

Modifier Description

* Check the CPT-4 book for guidelines.

2 Modifiers: Approved List
June 2009