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Modifiers 1

Modifiers 1



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Published by Karna

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Published by: Karna on Oct 08, 2008
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Modifiers for Medicare Billing
For Medicare purposes, modifiers are two-digit codes appended to procedure codes, to provideadditional information about the billed procedure. In some cases, addition of a modifier may directlyaffect payment. Below is a list of modifiers including the modifier description.
Modifiers that are used on claims for ambulance services are created by combining two alpha characters.Each alpha character, with the exception of X, represents an origin (source) code or a destination code.The pair of alpha codes creates one modifier. The first position alpha code = origin; the second positionalpha code = destination.Origin and destination codes and their descriptions are listed below:D Diagnostic or therapeutic site other than "P" or "H" when these are used as origin codesE Residential, domiciliary, custodial facility, nursing homeG Hospital based dialysis facility (hospital or hospital related)H HospitalI Site of transfer (e.g., airport or helicopter pad) between modes of ambulance transportJ Non-hospital based dialysis facility N Skilled nursing facility (SNF) (Medicare certified beds)P Physician’s office (includes HMO non-hospital facility, clinic, etc.)R ResidenceS Scene of accident or acute eventX (Destination code only) Intermediate stop at physician’s office en route to the hospital (includesHMO non-hospital facility, clinic, etc.)QL Patient Pronounced dead after ambulance calledThe following modifiers are valid for Medicare; however, the services would be denied under MedicarePart B as a Part A expense.QMAmbulance service provided under arrangement by hospitalQNAmbulance service furnished directly by hospital1
Billing indicators, listed below, can be used to further clarify the services provided. These billingindicators may be used as additional modifiers.1A Bedridden2A Accidental injury home/nursing home3A Accidental injury car 4A Patient in shock 5A Oxygen used and/or heart monitor used6A Transported by stretcher 7A Fracture to hip, leg, knee, trunk (same day as ambulance trip)8A Hospital lacks facility (patient admitted to second hospital)9A Rectal bleeding1B Myocardial infarction2B Possible cerebral vascular accident (CVA)3B Black out, passed out4B Laceration of head5B Dead on Arrival (DOA) at hospital6B Died in route to hospital7B Unresponsive or coma8B Quadriplegia9B Stroke (same day as ambulance trip)1C Paralysis2C Mentally retarded2
AH Clinical Psychologist (CP)AJ Clinical Social Worker (CSW)AK Nurse Practitioner, rural, team member AL Nurse Practitioner, non-rural, team member AM Physician, team member serviceAN Physician Assistant (PA) services, for other than assistant-at-surgery, non-team member AS PA, Nurse Practitioner, or Clinical Nurse Specialist services for assistant-at-surgeryAU PA services, other than assistant-at-surgery, team member AV Nurse Practitioner, rural, non-team member AW Clinical Nurse Specialist, non-team member AY Clinical Nurse Specialist, team member GN Service delivered personally by a speech-language pathologist or under an outpatient speech-language pathology plan of careGO Service delivered personally by an occupational therapist or under an outpatient occuptional therapy plan of careGP Service delivered personally by a physical therapist or under an outpatient physical therapy plan of careGT Via interactive audio and video telecommunication systemsGX Service not covered by Medicare
AA Anesthesia services personally performed by anesthesiologistAD Medical supervision by a physician: More than 4 concurrent anesthesia proceduresAE Direction of residents in furnishing not more than two concurrent anesthesia services - attending physician relationship metQK Medical direction of 2, 3, or 4 concurrent anesthesia procedures involving qualified individualsQS Monitored anesthesia careQX CRNA service with medical direction by physicianQY Medical direction of one concurrent anesthesia procedure involving qualified individualsQZ CRNA service without medical direction by a physician23 Unusual anesthesia - Used to report a procedure which usually requires either no anesthesia or localanesthesia; however, because of unusual circumstances must be done under general anesthesia47 Anesthesia by surgeon - Used to report regional or general anesthesia provided by the surgeon (notfor local anesthesia) 3

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