Modifiers - Full List
| Modifiers | Description |
| CG | Policy criteria applied - reserved for use with Medicaid |
| CR | Catastrophe / disaster related |
| CS | Identify the service as subject to the cost-sharing wavier for COVID-19 testing-related services |
| DC | Diagnostic / therapeutic site other than P/H to a community mental health center |
| DE | Diagnostic / therapeutic site other than P/H to a residential/domiciliary/custodial fac. |
| DF | Diagnostic / therapeutic site other than P/H to a federally qualified health center |
| DG | Diagnostic / therapeutic site other than P/H to a hospital-based dialysis facility |
| DH | Diagnostic / therapeutic site other than P/H to a Hospital |
| DI | Diagnostic / therapeutic site other than P/H to a site of ambulance transport modes transfer |
| DJ | Diagnostic / therapeutic site other than P/H to a non-hospital-based dialysis facility |
| DN | Diagnostic site / Skilled nursing facility |
| DP | Diagnostic / therapeutic site other than P/H to a physician's office |
| DR | Diagnostic site / residence |
| DS | Diagnostic / therapeutic site other than P/H to a scene of accident / acute event |
| DU | Diagnostic / therapeutic site other than P/H to urgent care |
| DX | Diagnostic / therapeutic site other than P/H to an intermediate stop at physician's office |
| ED | Residential / domiciliary / custodial fac. to a community mental health center |
| EE | Residential / domiciliary / custodial fac. to another residential / domiciliary /custodial fac. |
| EF | Residential / domiciliary / custodial fac. to a federally qualified heath center |
| EG | Residential / domiciliary / custodial fac. to a hospital-based dialysis facility |
| EH | Extended care / hospital |
| EI | Residential / domiciliary / custodial fac. to a site of ambulance transport modes transfer |
| EJ | Residential / domiciliary / custodial fac. to a non-hospital-based dialysis facility |
| EN | Residential / domiciliary / custodial fac. to a skilled nursing facility (SNF) |
| EO | Residential / domiciliary / custodial fac. to a physician office |
| EP | Service provided as part of Medicaid early periodic screening diagnosis and treatment (EPSDT) program |
| ER | Residential / domiciliary / custodial fac. to a residence |
| ES | Residential / domiciliary / custodial fac. to a scene of accident / acute event |
| ET | Emergency services |
| EU | Residential / domiciliary / custodial fac. to an Urgent Care |
| EW | Residential / domiciliary / custodial fac. with treatment in place or via telehealth service |
| EX | Residential / domiciliary / custodial fac. to an intermediate stop at physician's office |
| EY | No physician or other licensed health care provider order for this item or service |
| G1 | Most recent Urea Reduction Ration (URR) of less than 60% |
| G2 | Most recent Urea Reduction Ration (URR) of 60% to 64.9% |
| G3 | Most recent Urea Reduction Ration (URR) of 65% to 69.9% |
| G4 | Most recent Urea Reduction Ration (URR) of 70% to 74.9% |
| G5 | Most recent Urea Reduction Ration (URR) of 75% or greater |
| G6 | ESRD patient for whom less than seven (7) dialysis session have been provided in a month |
| GA | Waiver of liability statement issued as required by payer policy, individual case |
| GD | Hospital - based dialysis facility to a diagnostic / therapeutic site other than P/H |
| GE | Hospital - based dialysis facility to a residential / domiciliary /custodial fac. |
| GG | Hospital - based dialysis facility to an other hospital-based dialysis facility |
| GH | Hospital - based dialysis facility to a hospital |
| GI | Hospital - based dialysis facility to a state of ambulance transport modes transfer |
| GJ | Hospital - based dialysis facility to a non-hospital-based dialysis facility |
| GM | Multiple patients on one ambulance trip |
| GN | Hospital ESRD / skilled nursing facility |
| GP | Hospital - based dialysis facility to a physician's office |
| GR | Hospital ESRD /residence |
| GS | Hospital - based dialysis facility to a scene of accident / acute event |
| GT |
Via interactive audio and video telecommunications systems *Medicare no longer uses the GT modifier for professional services. However, many private payers still accept it. |
| GW | Service not related to the hospice patient's terminal condition |
| GX | Hospital - based dialysis facility to an intermediate stop at physician's office |
| GY | Item or service statutorily excluded, does not meet the definition of any Medicare benefit |
| GZ | Item or service expected to be denied as not reasonable and necessary |
| HA |
Child/adolescent program
|
| HD | Hospital to a diagnostic /therapeutic site other than P/H |
| HE | Hospital / extended care |
| HG | Hospital to a hospital-based dialysis facility |
| HH | Hospital / hospital |
| HI | Hospital to a site of ambulance transport modes transfer |
| HJ | Hospital to a non-hospital-based dialysis facility |
| HN | Hospital / skilled nursing facility |
| HP | Hospital to a physician's office |
| HR | Hospital / residence |
| HS | Hospital to scene of accident / acute event |
| HX | Hospital to intermediate stop at physician's office |
| ID | Site of ambulance transport modes transfer to a diagnostic / therapeutic site other than P/H |
| IE | Site of ambulance transport modes transfer to a residential / domiciliary / custodial fac. |
| IG | Site of ambulance transport modes transfer to a hospital - based dialysis facility |
| IH | Site of ambulance transport modes transfer to a hospital |
| II | Site of ambulance transport modes transfer to another site of ambulance transport modes transfer |
| IJ | Site of ambulance transport modes transfer to a non - hospital - based dialysis facility |
| IN | Site of ambulance transport modes transfer to a skilled nursing facility (SNF) |
| IP | Site of ambulance transport modes transfer to a physician's office |
| IR | Site of ambulance transport modes transfer to a residence |
| IS | Site of ambulance transport modes transfer to a scene of accident / acute event |
| IX | Site of ambulance transport modes transfer to an intermediate stop at physician's office |
| JC | Non - hospital - based dialysis facility to a community mental health center |
| JD | Non - hospital - based dialysis facility to a diagnostic / therapeutic site other than P/H |
| JE | Non - hospital - based dialysis facility to a residential /domiciliary / custodial fac. |
| JG | Non - hospital - based dialysis facility to a hospital - based dialysis facility |
| JH | Non - hospital - based dialysis facility to a hospital |
| JI | Non - hospital - based dialysis facility to a site of ambulance transport modes transfer |
| JJ | Non - hospital - based dialysis facility to another non - hospital - based dialysis facility |
| JN | Freestanding ESRD / skilled nursing facility |
| JP | Non - hospital - based dialysis facility to a physician's office |
| JR | Freestanding ESRD / residence |
| JS | Non - hospital - based dialysis facility to a scene of accident / acute event |
| JX | Non - hospital - based dialysis facility to an intermediate stop at physician's office |
| KF | Item designated by FDA as a class III device |
| KH | Dmepos item initial claim purchase or first month rental |
| KI | Dmepos item second or third month rental |
| KJ | Dmepos item months four to 15 |
| KX | Specific required documentation on file |
| LL | Lease / rental use the LL modifier when DME equipment rental is to applied against the purchase price |
| ND | Skilled nursing facility / diagnostic / therapeutic site other than P/H |
| NE | Skilled nursing facility (SNF) to residential / domiciliary / custodial fac. |
| NG | Skilled nursing facility / hospital ESRD |
| NH | Skilled nursing facility / hospital |
| NI | Skilled nursing facility (SNF) to a site of ambulance transport modes transfer |
| NJ | Skilled nursing facility / freestanding ESRD |
| NN | Skilled nursing facility (SNF) to another Skilled nursing facility (SNF) |
| NP | Skilled nursing facility / physician's office |
| NR | Skilled nursing facility to a residence |
| NS | Skilled nursing facility (SNF) to a scene of accident / acute event |
| NU | Skilled nursing facility to an urgent care |
| NX | Skilled nursing facility (SNP) to an intermediate stop at physician's office |
| PD | Physician's office to a diagnostic / therapeutic site other than P/H |
| PE | Physician's office to a residential / domiciliary / custodial fac. |
| PG | Physician's office to a hospital - based dialysis facility |
| PH | Physician's office / hospital |
| PI | Physician's office to a site of ambulance transport modes transfer |
| PJ | Physician's office to a non - hospital - based dialysis facility |
| PN | Physician's office / skilled nursing facility |
| PP | Physician's office to another physician's office |
| PR | Physician's office / residence |
| PS | Physician's office to a scene of accident /acute event |
| PX | Physician's office to an intermediate stop at physician's office |
| QJ | Services / items provided to a prisoner or patient in state or local custody |
| QL | Patient pronounced dead after ambulance called |
| QM | Ambulance service provided under arrangement by a provider of services |
| QN | Ambulance service furnished directly by a provider of services |
| RD | Residence / diagnostic site |
| RE | Residence to a residential / domiciliary / custodial fac. |
| RG | Residence / hospital ESRD |
| RH | Residence / hospital |
| RI | Residence to a site of ambulance transport modes transfer |
| RJ | Residence / freestanding ESRD |
| RN | Residence to a skilled nursing facility (SNF) |
| RO | Residence to a physician office |
| RP | Residence / physician's office |
| RR | Rental (use the 'RR' modifier when DME is be rented) |
| RS | Residence to a scene of accident / acute event |
| RX | Residence to an intermediate stop at physician's office |
| SD | Scene of accident / acute event to a diagnostic / therapeutic site other than P/H |
| SE | Scene of accident / acute event to a residential / domiciliary / custodial facility |
| SF | Scene of accident / acute event to a federally qualified health center |
| SG | Scene of accident / acute event to a hospital - based dialysis facility |
| SH | Scene / hospital |
| SI | Scene of accident / acute event to a site of ambulance transport modes transfer |
| SJ | Scene of accident / acute event to a non-hospital-based dialysis facility |
| SN | Scene of accident / acute event to a skilled nursing facility (SNF) |
| SP | Scene / physician's office |
| SR | Scene of accident / acute event to a residence |
| SS | Scene of accident / acute event to an other Scene of accident / acute event |
| SX | Scene of accident / acute event to an intermediate stop at physician's office |
| TK | Transporting more than one patient |
| TN | Pickup location is rural |
| TS | Two or more trips on the same day |
| TU | Special payment rate, overtime |
| U1 | Medicaid Level of Care 1, as defined by each state |
| U2 | Medicaid Level of Care 2, as defined by each state |
| U3 | Medicaid Level of Care 3, as defined by each state |
| U4 | Medicaid Level of Care 4, as defined by each state |
| UB | Medicaid Level of Care 11, as defined by each state |
| UJ | Services provided at night |
| UN | Two patients served |
| UP | Three patients served |
| UQ | Four patients served |
| UR | Five patients served |
| US | Six or more patient served |
| 59 | Distinct procedural service |
| 77 | Repeat procedure or service by the same physician or other qualified health care professional |