CPT/HCPCS modifier codes

When E&M visit + procedure happen same day and the E&M was separately documented from the procedure.

Splits a procedure into its professional (physician interpretation) and technical (facility) components.

Procedure performed on both sides of the body during a single session.

Multiple procedures performed at the same session.

Service partially reduced or eliminated at the physician's discretion.

Procedure discontinued because of extenuating circumstances.

E&M visit at which decision for major surgery was made.

Planned staged procedure in the postoperative period.

Procedure or service distinct from other services performed same day. Use only when no more-specific NCCI-edit modifier (XE, XS, XP, XU) applies.

Repeat of same procedure on same day by same physician.

Same procedure repeated by a different physician.

Patient returns to OR within global period for a related procedure.

Procedure during global period that's unrelated to the original procedure.

Repeat of same lab on same day to obtain multiple test results.

PA/NP/CNS billing as surgical assistant.

Provider has obtained ABN — patient responsible if Medicare denies.

Provider expects Medicare denial but no ABN obtained — patient cannot be billed.

The facility/equipment portion of a service.

Distinct procedure during a separate encounter on the same day (more specific than modifier 59).

Distinct procedure on a separate anatomic structure (more specific than modifier 59).