1. TrailBlazer Health Enterprises, LLC
EDUCATION MAKES THE DIFFERENCE
Medicare Part A Modifiers
Modifier Description
Significant, separately identifiable evaluation and management service by the same
25
physician on the same day of the procedure or other service
27 Multiple outpatient hospital evaluation/management encounters on the same day
50 Bilateral procedure
52 Reduced services
58 Staged or related procedure or service by the same physician during the postoperative
period
59 Distinct procedural service
73 Discontinued outpatient procedure prior to the administration of anesthesia
74 Discontinued outpatient procedure after the administration of anesthesia
76 Repeat procedure by same physician on same day
77 Repeat procedure by another physician on same day
78 Return to the operating room for a related procedure during the postoperative period
79 Unrelated procedure or service by the same physician during the postoperative period
91 Repeat clinical diagnostic laboratory test
Level II (HCPCS) Modifiers
BL Purchased blood and blood products
CA Procedure payable only in the inpatient setting when performed emergently on an
outpatient who expires prior to admission
EA Erythropoiesis Stimulating Agent (ESA) administered to treat anemia due to anti-
cancer chemotherapy
EB ESA administered to treat anemia due to anti-cancer radiotherapy
EC ESA administered to treat anemia not due to anti-cancer chemotherapy or anti-cancer
radiotherapy
Skilled Nursing Facility (SNF) Consolidated Billing (CB) Common Working File (CWF)
ET edit bypass for hospital Emergency Room (ER) services spanning multiple service
dates
E1 Upper left, eyelid
Published February 2008

2. Modifier Description
E2 Lower left, eyelid
E3 Upper right, eyelid
E4 Lower right, eyelid
FA Left hand, thumb
FB Item provided without cost or full credit received for replaced device
FC Partial credit received for replaced device
F1 Left hand, second digit
F2 Left hand, third digit
F3 Left hand, fourth digit
F4 Left hand, fifth digit
F5 Right hand, thumb
F6 Right hand, second digit
F7 Right hand, third digit
F8 Right hand, fourth digit
F9 Right hand, fifth digit
GA Waiver of liability statement on file
GG Performance and payment of a screening mammogram and diagnostic mammogram
on the same patient, same day
GH Diagnostic mammogram converted from screening mammogram on the same day
GN Service delivered under an outpatient speech-language pathology plan of care
GO Service delivered under an outpatient occupational therapy plan of care
GP Service delivered under an outpatient physical therapy plan of care
GS Dosage of epoetin or darbepoetin has been reduced 25 percent of preceding month’s
dosage
GY Item or service statutorily excluded or does not meet the definition of any Medicare
benefit
GZ Item or service expected to be denied as not reasonable and necessary
KX Therapy services that exceed the therapy cap
LC Left circumflex, coronary artery (hospitals use with codes 92980-92984, 92995, 92996)
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3. Modifier Description
LD Left anterior descending coronary artery (hospitals use with codes 92980-92984,
92995, 92996)
LT Left side (used to identify procedures performed on the left side of the body)
QM Ambulance service provided under arrangement by a provider of services
QN Ambulance service provided directly by a provider of services
Q0 (zero) Investigational clinical service provided in a clinical research study that is in an
approved clinical research study
Q1 Routine clinical service provided in a clinical research study that is in an approved
clinical research study
RC Right coronary artery (hospitals use with codes 92980-92984, 92995, 92996)
RT Right side (used to identify procedures performed on the right side of the body)
TA Left foot, great toe
T1 Left foot, second digit
T2 Left foot, third digit
T3 Left foot, fourth digit
T4 Left foot, fifth digit
T5 Right foot, great toe
T6 Right foot, second digit
T7 Right foot, third digit
T8 Right foot, fourth digit
T9 Right foot, fifth digit
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