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What Are HCPCS Modifiers Used For?

Health care coding professionals use HCPCS (Health care Common Procedure Coding System) modifiers to provide supplementary information concerning a procedure, service or item within the HCPCS coding scheme. In many cases, coders add modifiers to an existing HCPCS code, so insurance providers can process a claim for reimbursement. All claims for government insurance programs (e.g., Medicare) must include modifiers.

  1. Features

    • Modifiers are two digit numeric or alphanumeric characters used in HCPCS Level I (CPT) and HCPCS Level II codes.

    Considerations

    • In general, coders can add up to two modifiers to a single HCPCS code claim. However, on the CMS-1450 form (i.e., the UB-04 claim form) coders may include up to four modifiers.

    Function

    • A modifier signifies that a procedure, service or item has been amended, due to particular circumstances; it does not change the meaning of the code itself.

    Significance

    • Coders use HCPCS modifiers to detail the precise area on the body where a procedure took place (e.g., eyelids, hands, fingers, feet, toes or coronary arteries). Service modifiers are used when an extra service was performed, atypical events occurred during a service, the difficulty of performing the service increased or decreased, and when additional physicians administer services and/or service was administered at more than one setting.

    Identification

    • Some examples of HCPCS modifiers include: E1 (upper left, eyelid), E4 (lower right, eyelid), F5 (right hand, thumb), T2 (left foot, third digit), GM (multiple patients on one ambulance trip), QN (ambulance service furnished directly by a provider of services), and GP (service delivered personally by a physical therapist or under an outpatient physical therapy plan of care).

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