Procedure Code Modifier Utilization Listing (IB24-43)

Value

Name

Description

20

MICROSURGERY

MICROSURGERY

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.

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 CPTCODE WAS PERFORMED, THE PATIENT 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.

30

Description not found

Description not found

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 B 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 MANAGEMENT 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.

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 -5 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 COD 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 O THOSE THAT THREATEN THE WELL BEING OF THE PATIENT PRIOR TO OR AFTER ADMINISTRATION OF ANESTHESIA, SEE MODIFIERS -73 AND -74.

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 ADDIN THE MODIFIER -57 TO THE APPROPRIATE LEVEL OF E/M SERVICE, OR THE SEPARATE FIVE DIGIT MODIFIER 09957 MAY BE USED.

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, DIFFERNET 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 SAM PHYSICIAN. HOWEVER, WHAN ANOTHER ALREADY ESTABLISHED MODIFIER IS APPROPRIATE IT SHOULD BE USED RATHER THAN MODIFIER -59. ONL 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 ALTERNATE TO MODIFIER -59.

60

Description not found

Description not found

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.

63

PROCEDURE PERFORMED ON INFANTS LESS THAN 4 KG

PROCEDURE PERFORMED ON INFANTS LESS THAN 4 KG

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.

75

CONCURRENT CARE

CONCURRENT CARE

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 OR 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

RETURN TO THE OPERATING ROOM FOR A RELATED PROCEDURE DURING THE POSTOPERATIVE

78

RETURN TO THE OPERATING ROOM FOR A RELATED PROCEDURE DURING THE POSTOPERATIVE

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 T 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.

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 (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.

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.

AA

ANESTHESIA SERVICES PERFORMED PERSONALLY BY ANESTHESIOLOGIST

ANESTHESIA SERVICES PERFORMED PERSONALLY BY ANESTHESIOLOGIST

AB

ANESTHESIA SUPERVISION BY PHYSICIAN OF FOUR OR LESS CRNA EMPLOYEES - 30% PAYMENT (MOD 1)

ANESTHESIA SUPERVISION BY PHYSICIAN OF FOUR OR LESS CRNA EMPLOYEES - 30% PAYMENT (MOD 1)

AD

MEDICAL SUPERVISION BY A PHYSICIAN

MORE THAN FOUR CONCURRENT ANESTHESIA PROCEDURES

AE

REGISTERED DIETICIAN

REGISTERED DIETICIAN

AF

SPECIALTY PHYSICIAN

SPECIALTY PHYSICIAN (LIFT 10032)

AH

CLINICAL PSYCHOLOGIST

CLINICAL PSYCHOLOGIST

AI

PRINCIPAL PHYSICIAN OF RECORD

PRINCIPAL PHYSICIAN OF RECORD

AJ

CLINICAL SOCIAL WORKER

CLINICAL SOCIAL WORKER

AM

PHYSICIAN, TEAM MEMBER SERVICE

PHYSICIAN, TEAM MEMBER SERVICE (LIFT 10032)

AO

ALTERNATE PAYMENT METHOD DECLINED BY PROVIDER OF SERVICE

ALTERNATE PAYMENT METHOD DECLINED BY PROVIDER OF SERVICE

AR

PHYSICIAN PROVIDER SERVICES IN A PHYSICIAN SCARCITY AREA

PHYSICIAN PROVIDER SERVICES IN A PHYSICIAN SCARCITY AREA

AS

PHYSICIAN ASSISTANT, NURSE PRACTITIONER, OR CLINICAL NURSE SPECIALIST SERVICES FOR ASSISTANT AT SURGERY

PHYSICIAN ASSISTANT, NURSE PRACTITIONER, OR CLINICAL NURSE SPECIALIST SERVICES FOR ASSISTANT AT SURGERY

AT

ACUTE TREATMENT (THIS MODIFIER SHOULD BE USED WHEN REPORTING SERVICE 98940, 98941, 98942)

ACUTE TREATMENT (THIS MODIFIER SHOULD BE USED WHEN REPORTING SERVICE 98940, 98941, 98942)

AU

ITEM FURNISHED IN CONJUNCTION WITH A UROLOGICAL, OSTOMY, OR TRACHEOSTOMY SUPPLY

ITEM FURNISHED IN CONJUNCTION WITH A UROLOGICAL, OSTOMY, OR TRACHEOSTOMY SUPPLY

AV

ITEM FURNISHED IN CONJUNCTION WITH A PROSTHETIC DEVICE, PROSTHETIC OR ORTHOTIC

ITEM FURNISHED IN CONJUNCTION WITH A PROSTHETIC DEVICE, PROSTHETIC OR ORTHOTIC

AW

ITEM FURNISHED IN CONJUNCTION WITH A SURGICAL DRESSING

ITEM FURNISHED IN CONJUNCTION WITH A SURGICAL DRESSING

AX

ITEM FURNISHED IN CONJUNCTION WITH DIALYSIS SERVICES

ITEM FURNISHED IN CONJUNCTION WITH DIALYSIS SERVICES

AY

ITEM OR SERVICE FURNISHED TO AN ESRD PATIENT THAT IS NOT FOR THE TREATMENT OF ESRD

ITEM OR SERVICE FURNISHED TO AN ESRD PATIENT THAT IS NOT FOR THE TREATMENT OF ESRD

AZ

PHYSICIAN PROVIDING A SERVICE IN A DENTAL HEALTH PROFESSIONAL SHORTAGE AREA FOR THE PURPOSE OF AN ELECTRONIC HEALTH RECORD INCENTIVE PAYMENT

PHYSICIAN PROVIDING A SERVICE IN A DENTAL HEALTH PROFESSIONAL SHORTAGE AREA FOR THE PURPOSE OF AN ELECTRONIC HEALTH RECORD INCENTIVE PAYMENT

BA

ITEM FURNISHED IN CONJUNCTION WITH PARENTERAL ENTERAL NUTRITION (PEN) SERVICES

ITEM FURNISHED IN CONJUNCTION WITH PARENTERAL ENTERAL NUTRITION (PEN) SERVICES

BO

ORALLY ADMINISTERED NUTRITION, NOT BY FEEDING TUBE

ORALLY ADMINISTERED NUTRITION, NOT BY FEEDING TUBE

CC

PROCEDURE CODE CHANGE (USE 'CC' WHEN THE PROCEDURE CODE SUBMITTED WAS CHANGED EITHER FOR ADMINISTRATIVE REASONS OR BECAUSE AN INCORRECT CODE WAS FILED)

PROCEDURE CODE CHANGE (USE 'CC' WHEN THE PROCEDURE CODE SUBMITTED WAS CHANGED EITHER FOR ADMINISTRATIVE REASONS OR BECAUSE AN INCORRECT CODE WAS FILED)

CH

0 PERCENT IMPAIRED, LIMITED OR RESTRICTED

0 PERCENT IMPAIRED, LIMITED OR RESTRICTED

CI

AT LEAST 1 PERCENT BUT LESS THAN 20 PERCENT IMPAIRED, LIMITED OR RESTRICTED

AT LEAST 1 PERCENT BUT LESS THAN 20 PERCENT IMPAIRED, LIMITED OR RESTRICTED

CJ

AT LEAST 20 PERCENT BUT LESS THAN 40 PERCENT IMPAIRED, LIMITED OR RESTRICTED

AT LEAST 20 PERCENT BUT LESS THAN 40 PERCENT IMPAIRED, LIMITED OR RESTRICTED

CK

AT LEAST 40 PERCENT BUT LESS THAN 60 PERCENT IMPAIRED, LIMITED OR RESTRICTED

AT LEAST 40 PERCENT BUT LESS THAN 60 PERCENT IMPAIRED, LIMITED OR RESTRICTED

CL

AT LEAST 60 PERCENT BUT LESS THAN 80 PERCENT IMPAIRED, LIMITED OR RESTRICTED

AT LEAST 60 PERCENT BUT LESS THAN 80 PERCENT IMPAIRED, LIMITED OR RESTRICTED

CM

AT LEAST 80 PERCENT BUT LESS THAN 100 PERCENT IMPAIRED, LIMITED OR RESTRICTED

AT LEAST 80 PERCENT BUT LESS THAN 100 PERCENT IMPAIRED, LIMITED OR RESTRICTED

CN

100 PERCENT IMPAIRED, LIMITED OR
RESTRICTED

100 PERCENT IMPAIRED, LIMITED OR RESTRICTED

CR

CATASTROPHE/DISASTER RELATED

CATASTROPHE/DISASTER RELATED

CS

ITEM OR SERVICE RELATED, IN WHOLE OR IN PART, TO AN ILLNESS, INJURY, OR CONDITION THAT WAS CAUSED BY OR EXACERBATED BY THE EFFECTS, DIRECT OR INDIRECT, OF THE 2010 OIL SPILL IN THE GULF OF MEXICO, INCLUDING BUT NOT LIMITED TO SUBSEQUENT CLEAN-UP ACTIVITIE

ITEM OR SERVICE RELATED, IN WHOLE OR IN PART, TO AN ILLNESS, INJURY, OR CONDITION THAT WAS CAUSED BY OR EXACERBATED BY THE EFFECTS, DIRECT OR INDIRECT, OF THE 2010 OIL SPILL IN THE GULF OF MEXICO, INCLUDING BUT NOT LIMITED TO SUBSEQUENT CLEAN-UP ACTIVITIES

DA

ORAL HEALTH ASSESSMENT BY A LICENSED HEALTH PROFESSIONAL OTHER THAN A DENTIST

ORAL HEALTH ASSESSMENT BY A LICENSED HEALTH PROFESSIONAL OTHER THAN A DENTIST

E1

UPPER LEFT, EYELID

UPPER LEFT, EYELID

E2

LOWER LEFT, EYELID

LOWER LEFT, EYELID

E3

UPPER RIGHT, EYELID

UPPER RIGHT, EYELID

E4

LOWER RIGHT, EYELID

LOWER RIGHT, EYELID

EJ

SUBSEQUENT CLAIMS FOR A DEFINED COURSE OF THERAPY, E.G., EPO, SODIUM HYALURONATE, INFLIXIMAB

SUBSEQUENT CLAIMS FOR A DEFINED COURSE OF THERAPY, E.G., EPO, SODIUM HYALURONATE, INFLIXIMAB

EP

SERVICE PROVIDED AS PART OF MEDICAID EARLY PERIODIC SCREENING DIAGNOSIS AND TREATMENT (EPSDT) PROGRAM

SERVICE PROVIDED AS PART OF MEDICAID EARLY PERIODIC SCREENING DIAGNOSIS AND TREATMENT (EPSDT) PROGRAM

ET

EMERGENCY SERVICES

EMERGENCY SERVICES

F1

LEFT HAND, SECOND DIGIT

LEFT HAND, SECOND DIGIT

F2

LEFT HAND, THIRD DIGIT

LEFT HAND, THIRD DIGIT

F3

LEFT HAND, FOURTH DIGIT

LEFT HAND, FOURTH DIGIT

F4

LEFT HAND, FIFTH DIGIT

LEFT HAND, FIFTH DIGIT

F5

RIGHT HAND, THUMB

RIGHT HAND, THUMB

F6

RIGHT HAND, SECOND DIGIT

RIGHT HAND, SECOND DIGIT

F7

RIGHT HAND, THIRD DIGIT

RIGHT HAND, THIRD DIGIT

F8

RIGHT HAND, FOURTH DIGIT

RIGHT HAND, FOURTH DIGIT

F9

RIGHT HAND, FIFTH DIGIT

RIGHT HAND, FIFTH DIGIT

FA

LEFT HAND, THUMB

LEFT HAND, THUMB

FX

X-RAY TAKEN USING FILM

X-RAY TAKEN USING FILM

G7

PREGNANCY RESULTED FROM RAPE OR INCEST OR PREGNANCY CERTIFIED BY PHYSICIAN AS LIFE THREATENING

PREGNANCY RESULTED FROM RAPE OR INCEST OR PREGNANCY CERTIFIED BY PHYSICIAN AS LIFE THREATENING

G8

MONITORED ANESTHESIA CARE (MAC) FOR DEEP COMPLEX, COMPLICATED, OR MARKEDLY INVASIVE SURGICAL PROCEDURE

MONITORED ANESTHESIA CARE (MAC) FOR DEEP COMPLEX, COMPLICATED, OR MARKEDLY INVASIVE SURGICAL PROCEDURE

G9

MONITORED ANESTHESIA CARE FOR PATIENT WHO HAS HISTORY OF SEVERE CARDIO- PULMONARY CONDITION

MONITORED ANESTHESIA CARE FOR PATIENT WHO HAS HISTORY OF SEVERE CARDIO-PULMONARY CONDITION

GA

WAIVER OF LIABILITY STATEMENT ISSUED AS REQUIRED BY PAYER POLICY, INDIVIDUAL CASE

WAIVER OF LIABILITY STATEMENT ISSUED AS REQUIRED BY PAYER POLICY, INDIVIDUAL CASE

GB

CLAIM BEING RE-SUBMITTED FOR PAYMENT BECAUSE IT IS NO LONGER COVERED UNDER A GLOBAL PAYMENT DEMONSTRATION

CLAIM BEING RE-SUBMITTED FOR PAYMENT BECAUSE IT IS NO LONGER COVERED UNDER A GLOBAL PAYMENT DEMONSTRATION

GC

THIS SERVICE HAS BEEN PERFORMED IN PART BY A RESIDENT UNDER THE DIRECTION OF A TEACHING PHYSICIAN

THIS SERVICE HAS BEEN PERFORMED IN PART BY A RESIDENT UNDER THE DIRECTION OF A TEACHING PHYSICIAN

GN

SERVICES DELIVERED UNDER AN OUTPATIENT SPEECH LANGUAGE PATHOLOGY PLAN OF CARE

SERVICES DELIVERED UNDER AN OUTPATIENT SPEECH LANGUAGE PATHOLOGY PLAN OF CARE

GO

SERVICES DELIVERED UNDER AN OUTPATIENT OCCUPATIONAL THERAPY PLAN OF CARE

SERVICES DELIVERED UNDER AN OUTPATIENT OCCUPATIONAL THERAPY PLAN OF CARE

GP

SERVICES DELIVERED UNDER AN OUTPATIENT PHYSICAL THERAPY PLAN OF CARE

SERVICES DELIVERED UNDER AN OUTPATIENT PHYSICAL THERAPY PLAN OF CARE

GT

VIA INTERACTIVE AUDIO AND VIDEO TELECOMMUNICATION SYSTEMS

VIA INTERACTIVE AUDIO AND VIDEO TELECOMMUNICATION SYSTEMS

GU

WAIVER OF LIABILITY STATEMENT ISSUED AS REQUIRED BY PAYER POLICY, ROUTINE NOTICE

WAIVER OF LIABILITY STATEMENT ISSUED AS REQUIRED BY PAYER POLICY, ROUTINE NOTICE

GX

NOTICE OF LIABILITY ISSUED, VOLUNTARY UNDER PAYER POLICY

NOTICE OF LIABILITY ISSUED, VOLUNTARY UNDER PAYER POLICY

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

ITEM OR SERVICE STATUTORILY EXCLUDED, DOES NOT MEET THE DEFINITION OF ANY MEDICARE BENEFIT OR, FOR NON-MEDICARE INSURERS, IS NOT A CONTRACT BENEFIT

H9

COURT-ORDERED

COURT-ORDERED

HA

CHILD/ADOLESCENT PROGRAM

CHILD/ADOLESCENT PROGRAM

HB

ADULT PROGRAM, NON GERIATRIC

ADULT PROGRAM, NON GERIATRIC

HD

PREGNANT/PARENTING WOMEN'S PROGRAM

PREGNANT/PARENTING WOMEN'S PROGRAM

HE

MENTAL HEALTH PROGRAM

MENTAL HEALTH PROGRAM

HF

SUBSTANCE ABUSE PROGRAM

SUBSTANCE ABUSE PROGRAM

HH

INTEGRATED MENTAL HEALTH/SUBSTANCE ABUSE PROGRAM

INTEGRATED MENTAL HEALTH/SUBSTANCE ABUSE PROGRAM (LIFT 10032)

HI

INTEGRATED MENTAL HEALTH AND INTELLECTUAL DISABILITY/DEVELOPMENTAL DISABILITIES PROGRAM

INTEGRATED MENTAL HEALTH AND INTELLECTUAL DISABILITY/DEVELOPMENTAL DISABILITIES PROGRAM

HK

SPECIALIZED MENTAL HEALTH PROGRAMS FOR HIGH RISK POPULATIONS

SPECIALIZED MENTAL HEALTH PROGRAMS FOR HIGH RISK POPULATIONS (LIFT 10032)

HL

INTERN

INTERN

HM

LESS THAN BACHELOR DEGREE LEVEL

LESS THAN BACHELOR DEGREE LEVEL

HN

BACHELORS DEGREE LEVEL

BACHELORS DEGREE LEVEL

HO

MASTERS DEGREE LEVEL

MASTERS DEGREE LEVEL

HP

DOCTORAL LEVEL

DOCTORAL LEVEL

HQ

GROUP SETTING

GROUP SETTING

HR

FAMILY/COUPLE WITH CLIENT PRESENT

FAMILY/COUPLE WITH CLIENT PRESENT

HS

FAMILY/COUPLE WITHOUT CLIENT PRESENT

FAMILY/COUPLE WITHOUT CLIENT PRESENT

HU

FUNDED BY CHILD WELFARE AGENCY

FUNDED BY CHILD WELFARE AGENCY (LIFT 10032)

HW

FUNDED BY STATE MENTAL HEALTH AGENCY

FUNDED BY STATE MENTAL HEALTH AGENCY (LIFT 10032)

HY

FUNDED BY JUVENILE JUSTICE AGENCY

FUNDED BY JUVENILE JUSTICE AGENCY (LIFT 10032)

JE

ADMINISTERED VIA DIALYSATE

ADMINISTERED VIA DIALYSATE

JW

DRUG AMOUNT DISCARDED/NOT ADMINISTERED TO ANY PATIENT

DRUG AMOUNT DISCARDED/NOT ADMINISTERED TO ANY PATIENT

JZ

ZERO DRUG AMOUND DISCARDED/NOT ADMINISTERED TO ANY PATIENT

ZERO DRUG AMOUND DISCARDED/NOT ADMINISTERED TO ANY PATIENT

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.

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.

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.

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.

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.

KA

ADD ON OPTION/ACCESSORY FOR WHEELCHAIR

ADD ON OPTION/ACCESSORY FOR WHEELCHAIR

KM

REPLACEMENT OF FACIAL PROSTHESIS INCLUDING NEW IMPRESSION/MOULAGE

REPLACEMENT OF FACIAL PROSTHESIS INCLUDING NEW IMPRESSION/MOULAGE

KN

REPLACEMENT OF FACIAL PROSTHESIS USING PREVIOUS MASTER MODEL

REPLACEMENT OF FACIAL PROSTHESIS USING PREVIOUS MASTER MODEL

L1

PROVIDER ATTESTATION THAT THE HOSPITAL LABORATORY TEST(S) IS NOT PACKAGED UNDER THE HOSPITAL OPPS

PROVIDER ATTESTATION THAT THE HOSPITAL LABORATORY TEST(S) IS NOT PACKAGED UNDER THE HOSPITAL OPPS

LC

LEFT CIRCUMFLEX CORONARY ARTERY

LEFT CIRCUMFLEX CORONARY ARTERY

LD

LEFT ANTERIOR DESCENDING CORONARY ARTERY

LEFT ANTERIOR DESCENDING CORONARY ARTERY

LM

LEFT MAIN CORONARY ARTERY

LEFT MAIN CORONARY ARTERY

LM

LEFT MAIN CORONARY ARTERY

LEFT MAIN CORONARY ARTERY

LT

LEFT SIDE (USED TO IDENTIFY PROCEDURES PERFORMED ON THE LEFT SIDE OF THE BODY)

LEFT SIDE (USED TO IDENTIFY PROCEDURES PERFORMED ON THE LEFT SIDE OF THE BODY)

MH

NO DESCRIPTION FOUND

NO DESCRIPTION FOUND

PA

SURGICAL OR OTHER INVASIVE PROCEDURE ON WRONG BODY PART

SURGICAL OR OTHER INVASIVE PROCEDURE ON WRONG BODY PART

PB

SURGICAL OR OTHER INVASIVE PROCEDURE ON WRONG PATIENT

SURGICAL OR OTHER INVASIVE PROCEDURE ON WRONG PATIENT

PC

WRONG SURGERY OR OTHER INVASIVE PROCEDURE ON PATIENT

WRONG SURGERY OR OTHER INVASIVE PROCEDURE ON PATIENT

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

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

PN

NON-EXCEPTED OFF-CAMPUS SVC

NON-EXCEPTED OFF-CAMPUS SVC

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.

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.

PT

COLORECTAL CANCER SCREENING TEST; CONVERTED TO DIAGNOSTIC TEST OR OTHER PROCEDURE

COLORECTAL CANCER SCREENING TEST; CONVERTED TO DIAGNOSTIC TEST OR OTHER PROCEDURE

Q5

SERVICE FURNISHED BY A SUBSTITUTE PHYSICIAN UNDER A RECIPROCAL BILLING ARRANGEMENT

SERVICE FURNISHED BY A SUBSTITUTE PHYSICIAN UNDER A RECIPROCAL BILLING ARRANGEMENT

Q6

SERVICE FURNISHED BY A LOCUM TENENS PHYSICIAN

SERVICE FURNISHED BY A LOCUM TENENS PHYSICIAN

QD

RECORDING AND STORAGE IN SOLID STATE MEMORY BY A DIGITAL RECORDER

RECORDING AND STORAGE IN SOLID STATE MEMORY BY A DIGITAL RECORDER

QK

MEDICAL DIRECTION OF TWO, THREE, OR FOUR CONCURRENT ANESTHESIA PROCEDURES INVOLVING QUALIFIED INDIVIDUALS

MEDICAL DIRECTION OF TWO, THREE, OR FOUR CONCURRENT ANESTHESIA PROCEDURES INVOLVING QUALIFIED INDIVIDUALS

QQ

CLAIM SUBMITTED WITH A WRITTEN STATEMENT OF INTENT

CLAIM SUBMITTED WITH A WRITTEN STATEMENT OF INTENT

QS

MONITORED ANESTHESIA CARE SERVICE

MONITORED ANESTHESIA CARE SERVICE

QV

ITEM OR SERVICE PROVIDED AS ROUTINE CARE IN A MEDICARE QUALIFYING CLINICAL TRIAL

ITEM OR SERVICE PROVIDED AS ROUTINE CARE IN A MEDICARE QUALIFYING CLINICAL TRIAL

QW

CLIA WAIVED TEST

CLIA WAIVED TEST

QX

CRNA SERVICE

WITH MEDICAL DIRECTION BY A PHYSICIAN

QY

MEDICAL DIRECTION OF ONE CERTIFIED REGISTERED NURSE ANESTHETIST (CRNA) BY AN ANESTHESIOLOGIST

MEDICAL DIRECTION OF ONE CERTIFIED REGISTERED NURSE ANESTHETIST (CRNA) BY AN ANESTHESIOLOGIST

QZ

CRNA SERVICE

WITHOUT MEDICAL DIRECTION BY A PHYSICIAN

RB

DME PART REPLACEMENT

REPLACEMENT OF A PART OF DME FURNISHED AS PART OF A REPAIR

RC

RIGHT CORONARY ARTERY

RIGHT CORONARY ARTERY

RI

RAMUS INTERMEDIUS CORONARY ARTERY

RAMUS INTERMEDIUS CORONARY ARTERY

RP

REPLACEMENT AND REPAIR

MAY BE USED TO INDICATE REPLACEMENT OF DME, ORTHOTIC AND PROSTHETIC DEVICES WHICH HAVE BEEN IN USE FOR SOMETIME. THE CLAIM SHOWS THE CODE FOR THE PART, FOLLOWED BY THE 'RP' MODIFIER AND THE CHARGE FOR THE PART.

RR

RENTAL

USE THE 'RR' MODIFIER WHEN DME IS TO BE RENTED)

RT

RIGHT SIDE

USED TO IDENTIFY PROCEDURES PERFORMED ON THE RIGHT SIDE OF THE BODY

SA

NURSE PRACTITIONER W PHYSICIAN

NURSE PRACTITIONER W PHYSICIAN (LIFT 10032)

SE

STATE AND/OR FEDERALLY-FUNDED PROGRAMS/SERVICES

STATE AND/OR FEDERALLY-FUNDED PROGRAMS/SERVICES

SQ

ITEM ORDERED BY HOME HEALTH

ITEM ORDERED BY HOME HEALTH

T1

LEFT FOOT, SECOND DIGIT

LEFT FOOT, SECOND DIGIT

T2

LEFT FOOT, THIRD DIGIT

LEFT FOOT, THIRD DIGIT

T3

LEFT FOOT, FOURTH DIGIT

LEFT FOOT, FOURTH DIGIT

T4

LEFT FOOT, FIFTH DIGIT

LEFT FOOT, FIFTH DIGIT

T5

RIGHT FOOT, GREAT TOE

RIGHT FOOT, GREAT TOE

T6

RIGHT FOOT, SECOND DIGIT

RIGHT FOOT, SECOND DIGIT

T7

RIGHT FOOT, THIRD DIGIT

RIGHT FOOT, THIRD DIGIT

T8

RIGHT FOOT, FOURTH DIGIT

RIGHT FOOT, FOURTH DIGIT

T9

RIGHT FOOT, FIFTH DIGIT

RIGHT FOOT, FIFTH DIGIT

TA

LEFT FOOT, GREAT TOE

LEFT FOOT, GREAT TOE

TD

RN

RN

TE

LPN/LVN

LPN/LVN

TF

INTERMEDIATE LEVEL OF CARE

INTERMEDIATE LEVEL OF CARE

TG

COMPLEX/HIGH TECH LEVEL OF CARE

COMPLEX/HIGH TECH LEVEL OF CARE

TH

OBSTETRICAL TREATMENT/SERVICES, PRENATAL OR POSTPARTUM

OBSTETRICAL TREATMENT/SERVICES, PRENATAL OR POSTPARTUM

TJ

PROGRAM GROUP, CHILD AND/OR ADOLESCENT

PROGRAM GROUP, CHILD AND/OR ADOLESCENT

TN

RURAL/OUTSIDE PROVIDERS' CUSTOMARY SERVICE AREA

RURAL/OUTSIDE PROVIDERS' CUSTOMARY SERVICE AREA

TS

FOLLOW-UP SERVICE

FOLLOW-UP SERVICE

TT

INDIVIDUALIZED SERVICE PROVIDED TO MORE THAN ONE PATIENT IN SAME SETTING

INDIVIDUALIZED SERVICE PROVIDED TO MORE THAN ONE PATIENT IN SAME SETTING

TU

SPECIAL PAYMENT RATE, OVERTIME

SPECIAL PAYMENT RATE, OVERTIME (LIFT 9865)

TV

SPECIAL PAYMENT RATES, HOLIDAYS/WEEKENDS

SPECIAL PAYMENT RATES, HOLIDAYS/WEEKENDS

U1

MEDICAID LEVEL OF CARE 1, AS DEFINED BY EACH STATE (DAY)

MEDICAID LEVEL OF CARE 1, AS DEFINED BY EACH STATE (DAY)

U2

MEDICAID LEVEL OF CARE 2, AS DEFINED BY EACH STATE (2ND HH VISIT ON SAME DOS)

MEDICAID LEVEL OF CARE 2, AS DEFINED BY EACH STATE (2ND HH VISIT ON SAME DOS)

U3

MEDICAID LEVEL OF CARE 3, AS DEFINED BY EACH STATE (3RD HH VISIT ON SAME DOS)

MEDICAID LEVEL OF CARE 3, AS DEFINED BY EACH STATE (3RD HH VISIT ON SAME DOS)

U4

MEDICAID LEVEL OF CARE 4, AS DEFINED BY EACH STATE (HOME MODIFICATIONS, RAMP)

MEDICAID LEVEL OF CARE 4, AS DEFINED BY EACH STATE (HOME MODIFICATIONS, RAMP)

U5

TYPE OF SERVICE 09 ONLY. OXYGEN PROBE FOR USE WITH OXIMETER DEVICE, DISPOSIBLE

TYPE OF SERVICE 09 ONLY. OXYGEN PROBE FOR USE WITH OXIMETER DEVICE, DISPOSIBLE

U6

MEDICAID LEVEL OF CARE 6, AS DEFINED BY EACH STATE (Day Habilitation)

MEDICAID LEVEL OF CARE 6, AS DEFINED BY EACH STATE (Day Habilitation)

U7

MEDICAID LEVEL OF CARE 7, AS DEFINED BY EACH STATE (PSYC)

MEDICAID LEVEL OF CARE 7, AS DEFINED BY EACH STATE (PSYC)

U8

MEDICAID LEVEL OF CARE 8, AS DEFINED BY EACH STATE (Services rendered in the Natural Environment (Home and Community)

MEDICAID LEVEL OF CARE 8, AS DEFINED BY EACH STATE (Services rendered in the Natural Environment (Home and Community)

U9

MEDICAID LEVEL OF CARE 9, AS DEFINED BY EACH STATE (DISASTER RELATED SERVICE OR ILLNESS)

MEDICAID LEVEL OF CARE 9, AS DEFINED BY EACH STATE (DISASTER RELATED SERVICE OR ILLNESS)

UA

MEDICAID LEVEL OF CARE 10, AS DEFINED BY EACH STATE (Employment Supported Personal Attendant Service (Ticket to Work)

MEDICAID LEVEL OF CARE 10, AS DEFINED BY EACH STATE (Employment Supported Personal Attendant Service (Ticket to Work)

UB

MEDICAID LEVEL OF CARE 11, AS DEFINED BY EACH STATE (LT-PCS)

MEDICAID LEVEL OF CARE 11, AS DEFINED BY EACH STATE (LT-PCS)

UC

MEDICAID LEVEL OF CARE 12, AS DEFINED BY EACH STATE (Charity Indicator )

MEDICAID LEVEL OF CARE 12, AS DEFINED BY EACH STATE (Charity Indicator )

UD

MEDICAID LEVEL OF CARE 13, AS DEFINED BY EACH STATE (Wheelchair Seating Evaluation )

MEDICAID LEVEL OF CARE 13, AS DEFINED BY EACH STATE (Wheelchair Seating Evaluation )

UF

SERVICES PROVIDED IN THE MORNING

SERVICES PROVIDED IN THE MORNING

UH

SERVICES PROVIDED IN THE EVENING

SERVICES PROVIDED IN THE EVENING

UJ

SERVICES PROVIDED AT NIGHT

SERVICES PROVIDED AT NIGHT

UK

SERVICES PROVIDED ON BEHALF OF THE CLIENT TO SOMEONE OTHER THAN THE CLIENT (COLLATERAL RELATIONSHIP) (INDEPENDENT JOB EMPLOYMENT)

SERVICES PROVIDED ON BEHALF OF THE CLIENT TO SOMEONE OTHER THAN THE CLIENT (COLLATERAL RELATIONSHIP) (INDEPENDENT JOB EMPLOYMENT)

UN

TWO PATIENTS SERVED

TWO PATIENTS SERVED

UP

THREE PATIENTS SERVED

THREE PATIENTS SERVED

UQ

FOUR PATIENTS SERVED

FOUR PATIENTS SERVED

UR

FIVE PATIENTS SERVED

FIVE PATIENTS SERVED

V1

DEMONSTRATION MODIFIER 1

DEMONSTRATION MODIFIER 1

V2

DEMONSTRATION MODIFIER 2

DEMONSTRATION MODIFIER 2

V3

DEMONSTRATION MODIFIER 3

DEMONSTRATION MODIFIER 3

V5

VASCULAR CATHETER

VASCULAR CATHETER

V6

ARTERIOVENOUS GRAFT

ARTERIOVENOUS GRAFT

V7

ARTERIOVENOUS FISTULA

ARTERIOVENOUS FISTULA

V8

INFECTION PRESENT

INFECTION PRESENT

V9

NO INFECTION PRESENT

NO INFECTION PRESENT

XE

SEPARATE ENCOUNTER

A SERVICE THAT IS DISTINCT BECAUSE IT OCCURRED DURING A SEPARATE ENCOUNTER

XP

SEPARATE PRACTITIONER

A SERVICE THAT IS DISTINCT BECAUSE IT WAS PERFORMED BY A DIFFERENT PRACTITIONER

XS

SEPARATE ORGAN/STRUCTURE

A SERVICE THAT IS DISTINCT BECAUSE IT WAS PERFORMED ON A SEPARATE ORGAN/STRUCTURE

XU

UNUSUAL SEPARATE SERVICE

THE USE OF A SERVICE THAT IS DISTINCT BECAUSE IT DOES NOT OVERLAP USUAL COMPONENTS OF THE MAIN SERVICE

ZB

PFIZER/HOSPIRA

PFIZER/HOSPIRA