HCPCS Range Modifiers for HCPCS codes

• 1 Dressing for one wound ( A1 )

• 2 Dressing for two wounds ( A2 )

• 3 Dressing for three wounds ( A3 )

• 4 Dressing for four wounds ( A4 )

• 5 Dressing for five wounds ( A5 )

• 6 Dressing for six wounds ( A6 )

• 7 Dressing for seven wounds ( A7 )

• 8 Dressing for eight wounds ( A8 )

• 9 Dressing for nine or more wounds ( A9 )

• 10 Anesthesia services performed personally by anesthesiologist ( AA )

• 11 Medical supervision by a physician: more than four concurrent anesthesia procedures ( AD )

• 12 Registered dietician ( AE )

• 13 Specialty physician ( AF )

• 14 Primary physician ( AG )

• 15 Clinical psychologist ( AH )

• 16 Principal physician of record ( AI )

• 17 Clinical social worker ( AJ )

• 18 Non participating physician ( AK )

• 19 Physician, team member service ( AM )

• 20 Alternate payment method declined by provider of service ( AO )

• 21 Determination of refractive state was not performed in the course of diagnostic ophthalmological examination ( AP )

• 22 Physician providing a service in an unlisted health professional shortage area (hpsa) ( AQ )

• 23 Physician provider services in a physician scarcity area ( AR )

• 24 Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery ( AS )

• 25 Acute treatment (this modifier should be used when reporting service 98940, 98941, 98942) ( AT )

• 26 Item furnished in conjunction with a urological, ostomy, or tracheostomy supply ( AU )

• 27 Item furnished in conjunction with a prosthetic device, prosthetic or orthotic ( AV )

• 28 Item furnished in conjunction with a surgical dressing ( AW )

• 29 Item furnished in conjunction with dialysis services ( AX )

• 30 Item or service furnished to an esrd patient that is not for the treatment of esrd ( AY )

• 31 Physician providing a service in a dental health professional shortage area for the purpose of an electronic health record incentive payment ( AZ )

• 32 Item furnished in conjunction with parenteral enteral nutrition (pen) services ( BA )

• 33 Special acquisition of blood and blood products ( BL )

• 34 Orally administered nutrition, not by feeding tube ( BO )

• 35 The beneficiary has been informed of the purchase and rental options and has elected to purchase the item ( BP )

• 36 The beneficiary has been informed of the purchase and rental options and has elected to rent the item ( BR )

• 37 The beneficiary has been informed of the purchase and rental options and after 30 days has not informed the supplier of his/her decision ( BU )

• 38 Procedure payable only in the inpatient setting when performed emergently on an outpatient who expires prior to admission ( CA )

• 39 Amcc test has been ordered by an esrd facility or mcp physician that is part of the composite rate and is not separately billable ( CD )

• 40 Amcc test has been ordered by an esrd facility or mcp physician that is a composite rate test but is beyond the normal frequency covered under the rate and is separately reimbursable based on medical necessity ( CE )

• 41 Amcc test has been ordered by an esrd facility or mcp physician that is not part of the composite rate and is separately billable ( CF )

• 42 Policy criteria applied ( CG )

• 43 0 percent impaired, limited or restricted ( CH )

• 44 At least 1 percent but less than 20 percent impaired, limited or restricted ( CI )

• 45 At least 20 percent but less than 40 percent impaired, limited or restricted ( CJ )

• 46 At least 40 percent but less than 60 percent impaired, limited or restricted ( CK )

• 47 At least 60 percent but less than 80 percent impaired, limited or restricted ( CL )

• 48 At least 80 percent but less than 100 percent impaired, limited or restricted ( CM )

• 49 100 percent impaired, limited or restricted ( CN )

• 50 Catastrophe/disaster related ( CR )

• 51 Cost-sharing waived for specified covid-19 testing-related services that result in and order for or administration of a covid-19 test and/or used for cost-sharing waived preventive services furnished via telehealth in rural health clinics and federally qualified health centers during the covid-19 public health emergency ( CS )

• 52 Oral health assessment by a licensed health professional other than a dentist ( DA )

• 53 Upper left, eyelid ( E1 )

• 54 Lower left, eyelid ( E2 )

• 55 Upper right, eyelid ( E3 )

• 56 Lower right, eyelid ( E4 )

• 57 Erythropoetic stimulating agent (esa) administered to treat anemia due to anti-cancer chemotherapy ( EA )

• 58 Erythropoetic stimulating agent (esa) administered to treat anemia due to anti-cancer radiotherapy ( EB )

• 59 Erythropoetic stimulating agent (esa) administered to treat anemia not due to anti-cancer radiotherapy or anti-cancer chemotherapy ( EC )

• 60 Hematocrit level has exceeded 39% (or hemoglobin level has exceeded 13.0 g/dl) for 3 or more consecutive billing cycles immediately prior to and including the current cycle ( ED )

• 61 Hematocrit level has not exceeded 39% (or hemoglobin level has not exceeded 13.0 g/dl) for 3 or more consecutive billing cycles immediately prior to and including the current cycle ( EE )

• 62 Subsequent claims for a defined course of therapy, e.g., epo, sodium hyaluronate, infliximab ( EJ )

• 63 Emergency reserve supply (for esrd benefit only) ( EM )

• 64 Service provided as part of medicaid early periodic screening diagnosis and treatment (epsdt) program ( EP )

• 65 Emergency services ( ET )

• 66 No physician or other licensed health care provider order for this item or service ( EY )

• 67 Left hand, second digit ( F1 )

• 68 Left hand, third digit ( F2 )

• 69 Left hand, fourth digit ( F3 )

• 70 Left hand, fifth digit ( F4 )

• 71 Right hand, thumb ( F5 )

• 72 Right hand, second digit ( F6 )

• 73 Right hand, third digit ( F7 )

• 74 Right hand, fourth digit ( F8 )

• 75 Right hand, fifth digit ( F9 )

• 76 Left hand, thumb ( FA )

• 77 Item provided without cost to provider, supplier or practitioner, or full credit received for replaced device (examples, but not limited to, covered under warranty, replaced due to defect, free samples) ( FB )

• 78 Partial credit received for replaced device ( FC )

• 79 Service provided as part of family planning program ( FP )

• 80 Most recent urr reading of less than 60 ( G1 )

• 81 Most recent urr reading of 60 to 64.9 ( G2 )

• 82 Most recent urr reading of 65 to 69.9 ( G3 )

• 83 Most recent urr reading of 70 to 74.9 ( G4 )

• 84 Most recent urr reading of 75 or greater ( G5 )

• 85 Esrd patient for whom less than six dialysis sessions have been provided in a month ( G6 )

• 86 Pregnancy resulted from rape or incest or pregnancy certified by physician as life threatening ( G7 )

• 87 Monitored anesthesia care (mac) for deep complex, complicated, or markedly invasive surgical procedure ( G8 )

• 88 Monitored anesthesia care for patient who has history of severe cardio-pulmonary condition ( G9 )

• 89 Waiver of liability statement issued as required by payer policy, individual case ( GA )

• 90 Claim being re-submitted for payment because it is no longer covered under a global payment demonstration ( GB )

• 91 This service has been performed in part by a resident under the direction of a teaching physician ( GC )

• 92 This service has been performed by a resident without the presence of a teaching physician under the primary care exception ( GE )

• 93 Non-physician (e.g. nurse practitioner (np), certified registered nurse anesthetist (crna), certified registered nurse (crn), clinical nurse specialist (cns), physician assistant (pa)) services in a critical access hospital ( GF )

• 94 Performance and payment of a screening mammogram and diagnostic mammogram on the same patient, same day ( GG )

• 95 Diagnostic mammogram converted from screening mammogram on same day ( GH )

• 96 "opt out" physician or practitioner emergency or urgent service ( GJ )

• 97 Reasonable and necessary item/service associated with a ga or gz modifier ( GK )

• 98 Medically unnecessary upgrade provided instead of non-upgraded item, no charge, no advance beneficiary notice (abn) ( GL )

• 99 Multiple patients on one ambulance trip ( GM )

• 100 Services delivered under an outpatient speech language pathology plan of care ( GN )

• 101 Services delivered under an outpatient occupational therapy plan of care ( GO )

• 102 Services delivered under an outpatient physical therapy plan of care ( GP )

• 103 Via asynchronous telecommunications system ( GQ )

• 104 This service was performed in whole or in part by a resident in a department of veterans affairs medical center or clinic, supervised in accordance with va policy ( GR )

• 105 Dosage of erythropoietin stimulating agent has been reduced and maintained in response to hematocrit or hemoglobin level ( GS )

• 106 Via interactive audio and video telecommunication systems ( GT )

• 107 Waiver of liability statement issued as required by payer policy, routine notice ( GU )

• 108 Notice of liability issued, voluntary under payer policy ( GX )

• 109 Item or service statutorily excluded, does not meet the definition of any medicare benefit or, for non-medicare insurers, is not a contract benefit ( GY )

• 110 Item or service expected to be denied as not reasonable and necessary ( GZ )

• 111 Court-ordered ( H9 )

• 112 Child/adolescent program ( HA )

• 113 Adult program, non geriatric ( HB )

• 114 Adult program, geriatric ( HC )

• 115 Mental health program ( HE )

• 116 Substance abuse program ( HF )

• 117 Opioid addiction treatment program ( HG )

• 118 Integrated mental health/substance abuse program ( HH )

• 119 Integrated mental health and intellectual disability/developmental disabilities program ( HI )

• 120 Employee assistance program ( HJ )

• 121 Specialized mental health programs for high-risk populations ( HK )

• 122 Intern ( HL )

• 123 Less than bachelor degree level ( HM )

• 124 Bachelors degree level ( HN )

• 125 Masters degree level ( HO )

• 126 Doctoral level ( HP )

• 127 Group setting ( HQ )

• 128 Family/couple with client present ( HR )

• 129 Family/couple without client present ( HS )

• 130 Multi-disciplinary team ( HT )

• 131 Funded by child welfare agency ( HU )

• 132 Funded state addictions agency ( HV )

• 133 Funded by state mental health agency ( HW )

• 134 Funded by county/local agency ( HX )

• 135 Funded by juvenile justice agency ( HY )

• 136 Funded by criminal justice agency ( HZ )

• 137 Competitive acquisition program no-pay submission for a prescription number ( J1 )

• 138 Competitive acquisition program, restocking of emergency drugs after emergency administration ( J2 )

• 139 Competitive acquisition program (cap), drug not available through cap as written, reimbursed under average sales price methodology ( J3 )

• 140 Dmepos item subject to dmepos competitive bidding program that is furnished by a hospital upon discharge ( J4 )

• 141 Administered intravenously ( JA )

• 142 Administered subcutaneously ( JB )

• 143 Skin substitute used as a graft ( JC )

• 144 Skin substitute not used as a graft ( JD )

• 145 Administered via dialysate ( JE )

• 146 Drug amount discarded/not administered to any patient ( JW )

• 147 Lower extremity prosthesis functional level 0 - does not have the ability or potential to ambulate or transfer safely with or without assistance and a prosthesis does not enhance their quality of life or mobility. ( K0 )

• 148 Lower extremity prosthesis functional level 1 - has the ability or potential to use a prosthesis for transfers or ambulation on level surfaces at fixed cadence. typical of the limited and unlimited household ambulator. ( K1 )

• 149 Lower extremity prosthesis functional level 2 - has the ability or potential for ambulation with the ability to traverse low level environmental barriers such as curbs, stairs or uneven surfaces. typical of the limited community ambulator. ( K2 )

• 150 Lower extremity prosthesis functional level 3 - has the ability or potential for ambulation with variable cadence. typical of the community ambulator who has the ability to transverse most environmental barriers and may have vocational, therapeutic, or exercise activity that demands prosthetic utilization beyond simple locomotion. ( K3 )

• 151 Lower extremity prosthesis functional level 4 - has the ability or potential for prosthetic ambulation that exceeds the basic ambulation skills, exhibiting high impact, stress, or energy levels, typical of the prosthetic demands of the child, active adult, or athlete. ( K4 )

• 152 Add on option/accessory for wheelchair ( KA )

• 153 Beneficiary requested upgrade for abn, more than 4 modifiers identified on claim ( KB )

• 154 Replacement of special power wheelchair interface ( KC )

• 155 Drug or biological infused through dme ( KD )

• 156 Bid under round one of the dmepos competitive bidding program for use with non-competitive bid base equipment ( KE )

• 157 Item designated by fda as class iii device ( KF )

• 158 Dmepos item subject to dmepos competitive bidding program number 1 ( KG )

• 159 Dmepos item, initial claim, purchase or first month rental ( KH )

• 160 Dmepos item, second or third month rental ( KI )

• 161 Dmepos item, parenteral enteral nutrition (pen) pump or capped rental, months four to fifteen ( KJ )

• 162 Dmepos item subject to dmepos competitive bidding program number 2 ( KK )

• 163 Dmepos item delivered via mail ( KL )

• 164 Replacement of facial prosthesis including new impression/moulage ( KM )

• 165 Replacement of facial prosthesis using previous master model ( KN )

• 166 Single drug unit dose formulation ( KO )

• 167 First drug of a multiple drug unit dose formulation ( KP )

• 168 Second or subsequent drug of a multiple drug unit dose formulation ( KQ )

• 169 Rental item, billing for partial month ( KR )

• 170 Glucose monitor supply for diabetic beneficiary not treated with insulin ( KS )

• 171 Beneficiary resides in a competitive bidding area and travels outside that competitive bidding area and receives a competitive bid item ( KT )

• 172 Dmepos item subject to dmepos competitive bidding program number 3 ( KU )

• 173 Dmepos item subject to dmepos competitive bidding program that is furnished as part of a professional service ( KV )

• 174 Dmepos item subject to dmepos competitive bidding program number 4 ( KW )

• 175 Requirements specified in the medical policy have been met ( KX )

• 176 Dmepos item subject to dmepos competitive bidding program number 5 ( KY )

• 177 New coverage not implemented by managed care ( KZ )

• 178 Left circumflex coronary artery ( LC )

• 179 Left anterior descending coronary artery ( LD )

• 180 Left main coronary artery ( LM )

• 181 Laboratory round trip ( LR )

• 182 Fda-monitored intraocular lens implant ( LS )

• 183 Left side (used to identify procedures performed on the left side of the body) ( LT )

• 184 Medicare secondary payer (msp) ( M2 )

• 185 Six month maintenance and servicing fee for reasonable and necessary parts and labor which are not covered under any manufacturer or supplier warranty ( MS )

• 186 Nebulizer system, any type, fda-cleared for use with specific drug ( NB )

• 187 New equipment ( NU )

• 188 A normal healthy patient ( P1 )

• 189 A patient with mild systemic disease ( P2 )

• 190 A patient with severe systemic disease ( P3 )

• 191 A patient with severe systemic disease that is a constant threat to life ( P4 )

• 192 A moribund patient who is not expected to survive without the operation ( P5 )

• 193 A declared brain-dead patient whose organs are being removed for donor purposes ( P6 )

• 194 Surgical or other invasive procedure on wrong body part ( PA )

• 195 Surgical or other invasive procedure on wrong patient ( PB )

• 196 Wrong surgery or other invasive procedure on patient ( PC )

• 197 Diagnostic or related non diagnostic item or service provided in a wholly owned or operated entity to a patient who is admitted as an inpatient within 3 days ( PD )

• 198 Positron emission tomography (pet) or pet/computed tomography (ct) to inform the initial treatment strategy of tumors that are biopsy proven or strongly suspected of being cancerous based on other diagnostic testing ( PI )

• 199 Progressive addition lenses ( PL )

• 200 Post mortem ( PM )

• 201 Colorectal cancer screening test; converted to diagnostic test or other procedure ( PT )

• 202 Investigational clinical service provided in a clinical research study that is in an approved clinical research study ( Q0 )

• 203 Routine clinical service provided in a clinical research study that is in an approved clinical research study ( Q1 )

• 204 Demonstration procedure/service ( Q2 )

• 205 Live kidney donor surgery and related services ( Q3 )

• 206 Service for ordering/referring physician qualifies as a service exemption ( Q4 )

• 207 Service furnished under a reciprocal billing arrangement by a substitute physician; or by a substitute physical therapist furnishing outpatient physical therapy services in a health professional shortage area, a medically underserved area, or a rural area ( Q5 )

• 208 Service furnished under a fee-for-time compensation arrangement by a substitute physician; or by a substitute physical therapist furnishing outpatient physical therapy services in a health professional shortage area, a medically underserved area, or a rural area ( Q6 )

• 209 One class a finding ( Q7 )

• 210 Two class b findings ( Q8 )

• 211 One class b and two class c findings ( Q9 )

• 212 Single channel monitoring ( QC )

• 213 Recording and storage in solid state memory by a digital recorder ( QD )

• 214 Prescribed Amount Of Stationary Oxygen While At Rest Is Less Than 1 Liter Per Minute (lpm) ( QE )

• 215 Prescribed Amount Of Stationary Oxygen While At Rest Exceeds 4 Liters Per Minute (lpm) And Portable Oxygen Is Prescribed ( QF )

• 216 Prescribed Amount Of Stationary Oxygen While At Rest Is Greater Than 4 Liters Per Minute (lpm) ( QG )

• 217 Oxygen conserving device is being used with an oxygen delivery system ( QH )

• 218 Services/items provided to a prisoner or patient in state or local custody, however the state or local government, as applicable, meets the requirements in 42 cfr 411.4 (b) ( QJ )

• 219 Medical direction of two, three, or four concurrent anesthesia procedures involving qualified individuals ( QK )

• 220 Patient pronounced dead after ambulance called ( QL )

• 221 Ambulance service provided under arrangement by a provider of services ( QM )

• 222 Ambulance service furnished directly by a provider of services ( QN )

• 223 Documentation is on file showing that the laboratory test(s) was ordered individually or ordered as a cpt-recognized panel other than automated profile codes 80002-80019, G0058, G0059, and G0060. ( QP )

• 224 Monitored anesthesia care service ( QS )

• 225 Recording and storage on tape by an analog tape recorder ( QT )

• 226 CLIA waived test ( QW )

• 227 Crna service: with medical direction by a physician ( QX )

• 228 Medical direction of one certified registered nurse anesthetist (crna) by an anesthesiologist ( QY )

• 229 Crna service: without medical direction by a physician ( QZ )

• 230 Replacement of a dme, orthotic or prosthetic item ( RA )

• 231 Replacement of a part of a dme, orthotic or prosthetic item furnished as part of a repair ( RB )

• 232 Right coronary artery ( RC )

• 233 Drug provided to beneficiary, but not administered "incident-to" ( RD )

• 234 Furnished in full compliance with fda-mandated risk evaluation and mitigation strategy (rems) ( RE )

• 235 Ramus intermedius coronary artery ( RI )

• 236 Right side (used to identify procedures performed on the right side of the body) ( RT )

• 237 Nurse practitioner rendering service in collaboration with a physician ( SA )

• 238 Nurse midwife ( SB )

• 239 Medically necessary service or supply ( SC )

• 240 Services provided by registered nurse with specialized, highly technical home infusion training ( SD )

• 241 State and/or federally-funded programs/services ( SE )

• 242 Second opinion ordered by a professional review organization (pro) per section 9401, p.l. 99-272 (100% reimbursement - no medicare deductible or coinsurance) ( SF )

• 243 Ambulatory surgical center (asc) facility service ( SG )

• 244 Second concurrently administered infusion therapy ( SH )

• 245 Third or more concurrently administered infusion therapy ( SJ )

• 246 Member of high risk population (use only with codes for immunization) ( SK )

• 247 State supplied vaccine ( SL )

• 248 Second surgical opinion ( SM )

• 249 Third surgical opinion ( SN )

• 250 Item ordered by home health ( SQ )

• 251 Home infusion services provided in the infusion suite of the iv therapy provider ( SS )

• 252 Related to trauma or injury ( ST )

• 253 Services provided by a certified diabetic educator ( SW )

• 254 Persons who are in close contact with member of high-risk population (use only with codes for immunization) ( SY )

• 255 Left foot, second digit ( T1 )

• 256 Left foot, third digit ( T2 )

• 257 Left foot, fourth digit ( T3 )

• 258 Left foot, fifth digit ( T4 )

• 259 Right foot, great toe ( T5 )

• 260 Right foot, second digit ( T6 )

• 261 Right foot, third digit ( T7 )

• 262 Right foot, fourth digit ( T8 )

• 263 Right foot, fifth digit ( T9 )

• 264 Left foot, great toe ( TA )

• 265 RN ( TD )

• 266 Lpn/lvn ( TE )

• 267 Intermediate level of care ( TF )

• 268 Complex/high tech level of care ( TG )

• 269 Obstetrical treatment/services, prenatal or postpartum ( TH )

• 270 Program group, child and/or adolescent ( TJ )

• 271 Extra patient or passenger, non-ambulance ( TK )

• 272 Early intervention/individualized family service plan (ifsp) ( TL )

• 273 Individualized education program (iep) ( TM )

• 274 Medical transport, unloaded vehicle ( TP )

• 275 Basic life support transport by a volunteer ambulance provider ( TQ )

• 276 School-based individualized education program (iep) services provided outside the public school district responsible for the student ( TR )

• 277 Follow-up service ( TS )

• 278 Individualized service provided to more than one patient in same setting ( TT )

• 279 Special payment rate, overtime ( TU )

• 280 Special payment rates, holidays/weekends ( TV )

• 281 Back-up equipment ( TW )

• 282 Medicaid level of care 1, as defined by each state ( U1 )

• 283 Medicaid level of care 2, as defined by each state ( U2 )

• 284 Medicaid level of care 3, as defined by each state ( U3 )

• 285 Medicaid level of care 4, as defined by each state ( U4 )

• 286 Medicaid level of care 5, as defined by each state ( U5 )

• 287 Medicaid level of care 6, as defined by each state ( U6 )

• 288 Medicaid level of care 7, as defined by each state ( U7 )

• 289 Medicaid level of care 8, as defined by each state ( U8 )

• 290 Medicaid level of care 9, as defined by each state ( U9 )

• 291 Medicaid level of care 10, as defined by each state ( UA )

• 292 Medicaid level of care 11, as defined by each state ( UB )

• 293 Medicaid level of care 12, as defined by each state ( UC )

• 294 Medicaid level of care 13, as defined by each state ( UD )

• 295 Used durable medical equipment ( UE )

• 296 Services provided in the morning ( UF )

• 297 Services provided in the afternoon ( UG )

• 298 Services provided in the evening ( UH )

• 299 Services provided at night ( UJ )

• 300 Services provided on behalf of the client to someone other than the client (collateral relationship) ( UK )

• 301 Two patients served ( UN )

• 302 Three patients served ( UP )

• 303 Four patients served ( UQ )

• 304 Five patients served ( UR )

• 305 Six or more patients served ( US )

• 306 Vascular catheter (alone or with any other vascular access) ( V5 )

• 307 Arteriovenous graft (or other vascular access not including a vascular catheter) ( V6 )

• 308 Arteriovenous fistula only (in use with two needles) ( V7 )

• 309 Aphakic patient ( VP )

• 310 Service ordered by a renal dialysis facility (rdf) physician as part of the esrd beneficiary's dialysis benefit, is not part of the composite rate, and is separately reimbursable ( CB )

• 311 Procedure code change (use 'CC' when the procedure code submitted was changed either for administrative reasons or because an incorrect code was filed) ( CC )

• 312 Attending physician not employed or paid under arrangement by the patient's hospice provider ( GV )

• 313 Service not related to the hospice patient's terminal condition ( GW )

• 314 Pregnant/parenting women's program ( HD )

• 315 Lease/rental (use the 'll' modifier when dme equipment rental is to be applied against the purchase price) ( LL )

• 316 New when rented (use the 'nr' modifier when dme which was new at the time of rental is subsequently purchased) ( NR )

• 317 Positron emission tomography (pet) or pet/computed tomography (ct) to inform the subsequent treatment strategy of cancerous tumors when the beneficiary's treating physician determines that the pet study is needed to inform subsequent anti-tumor strategy ( PS )

• 318 Rental (use the 'rr' modifier when dme is to be rented) ( RR )

• 319 Procedure performed in physician's office (to denote use of facility and equipment) ( SU )

• 320 Pharmaceuticals delivered to patient's home but not utilized ( SV )

• 321 Technical component; under certain circumstances, a charge may be made for the technical component alone; under those circumstances the technical component charge is identified by adding modifier 'tc' to the usual procedure number; technical component charges are institutional charges and not billed separately by physicians; however, portable x-ray suppliers only bill for technical component and should utilize modifier tc; the charge data from portable x-ray suppliers will then be used to build customary and prevailing profiles ( TC )

• 322 Rural/outside providers' customary service area ( TN )

• 323 Excepted service provided at an off-campus, outpatient, provider-based department of a hospital ( PO )

• 324 Separate encounter, a service that is distinct because it occurred during a separate encounter ( XE )

• 325 Separate practitioner, a service that is distinct because it was performed by a different practitioner ( XP )

• 326 Separate structure, a service that is distinct because it was performed on a separate organ/structure ( XS )

• 327 Unusual non-overlapping service, the use of a service that is distinct because it does not overlap usual components of the main service ( XU )

• 328 Expatriate Beneficiary ( EX )

• 329 Computed tomography services furnished using equipment that does not meet each of the attributes of the national electrical manufacturers association (nema) xr-29-2013 standard ( CT )

• 330 X-ray taken using film ( FX )

• 331 Non-excepted service provided at an off-campus, outpatient, provider-based department of a hospital ( PN )

• 332 Demonstration modifier 1 ( V1 )

• 333 Demonstration modifier 2 ( V2 )

• 334 Demonstration modifier 3 ( V3 )

• 335 X-ray taken using computed radiography technology/cassette-based imaging ( FY )

• 336 Drug or biological acquired with 340b drug pricing program discount, reported for informational purposes ( JG )

• 337 Drug or biological acquired with 340b drug pricing program discount, reported for informational purposes for select entities ( TB )

• 338 Continuous/broad services: for reporting services by clinicians, who provide the principal care for a patient, with no planned endpoint of the relationship; services in this category represent comprehensive care, dealing with the entire scope of patient problems, either directly or in a care coordination role; reporting clinician service examples include, but are not limited to: primary care, and clinicians providing comprehensive care to patients in addition to specialty care ( X1 )

• 339 Continuous/focused services: for reporting services by clinicians whose expertise is needed for the ongoing management of a chronic disease or a condition that needs to be managed and followed with no planned endpoint to the relationship; reporting clinician service examples include but are not limited to: a rheumatologist taking care of the patient's rheumatoid arthritis longitudinally but not providing general primary care services ( X2 )

• 340 Episodic/broad services: for reporting services by clinicians who have broad responsibility for the comprehensive needs of the patient that is limited to a defined period and circumstance such as a hospitalization; reporting clinician service examples include but are not limited to the hospitalist's services rendered providing comprehensive and general care to a patient while admitted to the hospital ( X3 )

• 341 Episodic/focused services: for reporting services by clinicians who provide focused care on particular types of treatment limited to a defined period and circumstance; the patient has a problem, acute or chronic, that will be treated with surgery, radiation, or some other type of generally time-limited intervention; reporting clinician service examples include but are not limited to, the orthopedic surgeon performing a knee replacement and seeing the patient through the postoperative period ( X4 )

• 342 Diagnostic services requested by another clinician: for reporting services by a clinician who furnishes care to the patient only as requested by another clinician or subsequent and related services requested by another clinician; this modifier is reported for patient relationships that may not be adequately captured by the above alternative categories; reporting clinician service examples include but are not limited to, the radiologist's interpretation of an imaging study requested by another clinician ( X5 )

• 343 Prescribed Amounts Of Stationary Oxygen For Daytime Use While At Rest And Nighttime Use Differ And The Average Of The Two Amounts Is Less Than 1 Liter Per Minute (LPM) ( QA )

• 344 Prescribed Amounts Of Stationary Oxygen For Daytime Use While At Rest And Nighttime Use Differ And The Average Of The Two Amounts Exceeds 4 Liters Per Minute (LPM) And Portable Oxygen Is Prescribed ( QB )

• 345 Prescribed Amounts Of Stationary Oxygen For Daytime Use While At Rest And Nighttime Use Differ And The Average Of The Two Amounts Is Greater Than 4 Liters Per Minute (LPM) ( QR )

• 346 Medicare diabetes prevention program (mdpp) virtual make-up session ( VM )

• 347 Ordering professional consulted a qualified clinical decision support mechanism for this service and the related data was provided to the furnishing professional ( QQ )

• 348 Outpatient occupational therapy services furnished in whole or in part by an occupational therapy assistant ( CO )

• 349 Outpatient physical therapy services furnished in whole or in part by a physical therapist assistant ( CQ )

• 350 Items and services furnished by a provider-based, off-campus emergency department ( ER )

• 351 Telehealth Services For Diagnosis, Evaluation, Or Treatment, Of Symptoms Of An Acute Stroke ( G0 )

• 352 Ordering professional is not required to consult a clinical decision support mechanism due to service being rendered to a patient with a suspected or confirmed emergency medical condition ( MA )

• 353 Ordering professional is not required to consult a clinical decision support mechanism due to the significant hardship exception of insufficient internet access ( MB )

• 354 Ordering professional is not required to consult a clinical decision support mechanism due to the significant hardship exception of electronic health record or clinical decision support mechanism vendor issues ( MC )

• 355 Ordering professional is not required to consult a clinical decision support mechanism due to the significant hardship exception of extreme and uncontrollable circumstances ( MD )

• 356 The order for this service adheres to appropriate use criteria in the clinical decision support mechanism consulted by the ordering professional ( ME )

• 357 The order for this service does not adhere to the appropriate use criteria in the clinical decision support mechanism consulted by the ordering professional ( MF )

• 358 The order for this service does not have applicable appropriate use criteria in the qualified clinical decision support mechanism consulted by the ordering professional ( MG )

• 359 Unknown if ordering professional consulted a clinical decision support mechanism for this service, related information was not provided to the furnishing professional or provider ( MH )

• 360 Off-the-shelf orthotic subject to dmepos competitive bidding program that is furnished as part of a physical therapist or occupational therapist professional service ( J5 )

• 361 Demonstration modifier 4 ( V4 )

• 362 The service was furnished using audio-only communication technology ( FQ )

• 363 The supervising practitioner was present through two-way, audio/video communication technology ( FR )

• 364 Split (or shared) evaluation and management visit ( FS )

• 365 Unrelated evaluation and management (e/m) visit on the same day as another e/m visit or during a global procedure (preoperative, postoperative period, or on the same day as the procedure, as applicable). (report when an e/m visit is furnished within the global period but is unrelated, or when one or more additional e/m visits furnished on the same day are unrelated) ( FT )

• 366 Fractionated payment ( LU )

• 367 Group 3 oxygen coverage criteria met ( N3 )

• 368 Group 2 oxygen coverage criteria met ( N2 )

• 369 Group 1 oxygen coverage criteria met ( N1 )

• 370 Zero drug amount discarded/not administered to any patient ( JZ )

• 371 One month supply or less of drug or biological ( JK )

• 372 Three month supply of drug or biological ( JL )

• 373 Audiology service furnished personally by an audiologist without a physician/npp order for non-acute hearing assessment unrelated to disequilibrium, or hearing aids, or examinations for the purpose of prescribing, fitting, or changing hearing aids; service may be performed once every 12 months, per beneficiary ( AB )