CPT Modifier Reference

Work required to provide the service was substantially greater than typically required.

Common use: Complex surgeries, unusual anatomical conditions, or prolonged procedures.

A significant, separately identifiable E/M service was provided on the same day as a procedure.

Common use: Office visit on same day as a minor procedure such as a skin biopsy or injection.

Identifies the physician professional component (interpretation) of a service that has both a professional and technical component.

Common use: Radiologist reading an X-ray; cardiologist interpreting an ECG.

Service was mandated by a third party such as a payer, employer, or government entity.

Common use: Independent medical examinations (IMEs), pre-employment physicals required by employer.

Service is preventive and would be covered at no cost-sharing under the ACA.

Common use: Immunizations, cancer screenings, and other USPSTF Grade A/B preventive services.

Regional or general anesthesia was administered by the surgeon who performed the procedure.

Common use: Surgeon provides their own anesthesia for a procedure.

Procedure was performed on both sides of the body during the same operative session.

Common use: Bilateral knee injections, bilateral tympanostomy tubes, bilateral carpal tunnel release.

More than one procedure other than E/M was performed at the same session by the same provider.

Common use: Two separate surgical procedures performed during the same operative session.

Service or procedure was reduced or eliminated at the physician's discretion.

Common use: Incomplete colonoscopy; procedure terminated early due to patient condition.

Procedure was started but discontinued due to extenuating circumstances or risk to patient well-being.

Common use: Procedure terminated after anesthesia induction but before the surgical incision.

One physician performs the surgical procedure while another provides pre- and postoperative care.

Common use: Surgeon performs an operation; another physician provides the pre- and postoperative management.

Provider is responsible only for postoperative management of the patient.

Common use: Primary care physician manages postoperative care while a surgeon performed the operation.

Provider performs preoperative care only and is not the operating surgeon.

Common use: Separate physician handles preoperative evaluation and preparation.

The E/M service resulting in the initial decision to perform surgery was provided on the day before or day of a major surgery.

Common use: Office or ED visit on the day of or day before a major (90-day global) surgical procedure.

Procedure or service is distinct or independent from other services performed on the same day.

Common use: Two procedures that would normally be bundled together are distinct in this encounter.

Two surgeons (each in a different specialty) are required to perform a specific procedure.

Common use: Complex spinal surgery requiring both a neurosurgeon and an orthopaedic surgeon.

Highly complex procedures requiring the concurrent services of multiple physicians and other qualified personnel.

Common use: Multi-team organ transplant procedures.

Procedure or service was repeated subsequent to the original procedure or service by the same physician or other qualified healthcare professional.

Common use: Second EKG on the same day by the same physician to assess change in status.

Procedure or service was repeated by a different physician or other qualified healthcare professional.

Common use: Second reading of an X-ray by a different radiologist.

Unplanned return to the operating room by the same physician following initial procedure for a related procedure during the postoperative period.

Common use: Return to OR for bleeding or wound complication during the global period.

Procedure performed during the postoperative period was unrelated to the original procedure.

Common use: Appendectomy performed during the postoperative period of a knee replacement.

Surgical assistant services provided by a physician.

Common use: Second surgeon assists during a complex procedure; payer policy governs how the assistant is reimbursed.

Minimum surgical assistant services provided by a physician.

Common use: Assistant surgeon provides brief, limited assistance during a portion of the procedure.

Repeat clinical diagnostic laboratory test performed on the same day to obtain subsequent results.

Common use: Serial glucose or troponin levels throughout the same day.

Services rendered via real-time telephone interaction between a physician and a patient.

Common use: Telephone-only E/M visit without video capability.

Synchronous telemedicine service rendered via a real-time interactive audio and video telecommunications system.

Common use: Video-enabled telehealth visit; primary modifier for billing most telehealth E/M services.

Used under Medicare to indicate a service was provided via interactive audio and video telecommunication systems.

Common use: Medicare telehealth services; often used alongside 95 or alone depending on payer policy.

Procedure was performed on the left side of the body.

Common use: Left knee injection, left carpal tunnel release, left hip arthroplasty.

Procedure was performed on the right side of the body.

Common use: Right shoulder repair, right inguinal hernia repair, right total hip arthroplasty.

Identifies the technical component of a service — the equipment, supplies, and non-physician staff involved.

Common use: Imaging center billing for the equipment and staff when the physician reads separately.