Modifiers - AAPC

1 CPT ModifiersModifierDescription22 Increased Procedural Services23 Unusual Anesthesia24 Unrelated Evaluation and Management Service by the Same Physician or Other Qualified Health Care Professional During a Postoperative Period25 Significant, Separately Identifiable Evaluation and Management Service by the Same Physician or Other Qualified Health Care Professional on the Same Day of the Procedure or Other Service26 Professional Component27 Multiple Outpatient Hospital E/M Encounters on the Same Date32 Mandated Services33 Preventive Services47 Anesthesia by Surgeon50 Bilateral Procedure51 Multiple Procedures52 Reduced Services53 Discontinued Procedure54 Surgical Care Only55 Postoperative Management Only56 Preoperative Management Only57 Decision for Surgery58 Staged or Related Procedure or Service by the Same Physician or Other Qualified Health Care Professional During the Postoperative Period59 Distinct Procedural Service62 Two Surgeons63 Procedure Performed on Infants less than 4 kg66 Surgical Team73 Discontinued Out-Patient Hospital/Ambulatory Surgery Center (ASC)

2 Procedure Prior to the Administration of Anesthesia74 Discontinued Out-Patient Hospital/Ambulatory Surgery Center (ASC) Procedure After Administration of Anesthesia76 Repeat Procedure or Service by Same Physician or Other Qualified Health Care Professional77 Repeat Procedure by Another Physician or Other Qualified Health Care Professional78 Unplanned Return to the Operating/Procedure Room by the Same Physician or Other Qualified Health Care Professional Following Initial Procedure for a Related Procedure During the Postoperative Period79 Unrelated Procedure or Service by the Same Physician or Other Qualified Health Care Professional During the Postoperative Period80 Assistant Surgeon81 Minimum Assistant Surgeon82 Assistant Surgeon (when qualified resident surgeon not available)90 Reference (Outside) Laboratory91 Repeat Clinical Diagnostic Laboratory Test92 Alternative Laboratory Platform Testing95 Synchronous Telemedicine Service Rendered Via a Real-Time Interactive Audio and Video Telecommunications System96 Habilitative Services97 Rehabilitative Services99 Multiple ModifiersCategory II ModifiersModifierDescription1 PPerformance Measure Exclusion Modifier due to Medical Reasons2 PPerformance Measure Exclusion Modifier due to Patient Reasons3 PPerformance Measure Exclusion Modifier due to System Reasons8 PPerformance Measure Reporting Modifier - Action Not Performed.

3 Reason Not Otherwise SpecifiedHCPCS ModifiersModifierDescriptionA1 Dressing for one woundA2 Dressing for two woundsA3 Dressing for three woundsA4 Dressing for four woundsA5 Dressing for five woundsA6 Dressing for six woundsA7 Dressing for seven woundsA8 Dressing for eight woundsA9 Dressing for nine or more woundsAAAnesthesia services performed personally by anesthesiologistADMedical supervision by a physician: more than four concurrent anesthesia proceduresModifierDescriptionAERegistere d dieticianAFSpecialty physicianAGPrimary physicianAHClinical psychologistAIPrincipal physician of recordAJClinical social workerAKNon participating physicianAMPhysician, team member serviceAOAlternate payment method declined by provider of serviceAPDetermination of refractive state was not performed in the course of diagnostic ophthalmological examinationModifierDescriptionAQPhysicia n providing a service in an unlisted health professional shortage area (HPSA)ARPhysician provider services in a physician scarcity areaASPhysician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgeryATAcute treatment (this modifier should be used when reporting service 98940, 98941, 98942)

4 AUItem furnished in conjunction with a urological, ostomy, or tracheostomy supplyTable of ContentsIntroduction yFeatures, Symbols, and Conventions 3 Instructions for Using This Manual 4 Anatomical Illustrations 5 New/Revised/Deleted Codes Advice for 2020 41 CPT Modifiers , Definitions, and Tips 97 HCPCS Modifiers , Definitions, and Tips 109 Index 177 Code Chapters 441 yEvaluation and Management Services 441 yAnesthesia 471 ySurgery Surgery/General 491 Surgery/Integumentary System 493 Surgery/Musculoskeletal System 533 Surgery/Respiratory System 671 Surgery/Cardiovascular System 695 Surgery/Hemic and LymphaticSystems 757 Surgery/Mediastinum and Diaphragm 763 Surgery/Digestive System 765 Surgery/Urinary System 829 Surgery/Male Genital System 855 Surgery/Reproductive System 867 Surgery/Intersex Surgery 869 Surgery/Female Genital

5 System 871 Surgery/Maternity Care and Delivery 889 Surgery/Endocrine System 895 Surgery/Nervous System 899 Surgery/Eye and Ocular Adnexa 939 Surgery/Auditory System 963 Surgery/Operating Microscope 971 yRadiology Procedures 973 yPathology and Laboratory Procedures 1021 yMedicine Services and Procedures 1135 yCategory II Codes 1223 yCategory III Codes 1243 yMultianalyte Assays 1269 yProprietary Laboratory Analyses 1271 Appendices yAppendix A: New, Revised, and Deleted Codes for 2020 1283 yAppendix B: Crosswalks for Deleted Codes 1285 yAppendix C: Inpatient-Only Procedure Codes 1287 yAppendix D: Category II Modifiers 1293 yAppendix E: HCPCS Level II Modifiers 1295 yAppendix F: Resequenced CPT Codes 1303 yAppendix G: Vascular Families for Interventional Radiology Coding 1305 yAppendix H: Modifier 51 Exempt, Modifier 63 Exempt, and Add-On Codes 1311 yAppendix I: Brand-Name and Generic Vaccinations Associated With CPT Codes 1313 yAppendix J: Place of Service/Type of Service 1315 yAppendix K: Drug Class List 1319 yAppendix L: APC Status Indicators 1337 yAppendix M: ASC Payment Indicators 1339 17 AnAtomicAl illustrAtionsAnatomical illustrationsTitle: Skin , Author: Madhero88, Source: Own work, License/Permission.

6 This file is licensed under the Creative Commons Attribution-Share Alike Unported license., URL link: AnAtomicAl illustrAtionsAnatomical illustrations 177 CPT is a registered trademark of the American Medical Association. All rights (Vitamin A) Abdomen or Abdominal, X-rayIndexAA (Vitamin A) 84590A-II (Angiotensin II) 82163Ab Externo Trabeculectomy (AET) 65850 Abbe-Estlander Reconstruction ProcedureLip Excision 40527 Plastic repair With Sectioning and Inserting Pedicle 40761 Abdomen or AbdominalAbscess Incision and DrainagePeritoneal 49020 Retroperitoneal 49060 Subphrenic 49040 Anesthesia, See Anesthesia, AbdomenAngiographyCT With Contrast Material 74174, 74175, 75635 Magnetic Resonance (MRA) 74185 AortaAngiography 75635 Aortography 75625, 75630 Thromboendarterectomy 35331 Aortic AneurysmEndovascular 34701-34708 Device Placement 34808 Open repair 34832, 34841-34848, 35081-35103 Prosthesis or Graft 34813, 34820, 34709-34711 Exposure 34812 Infrarenal repair 34830, 34831, 34832 Open Exposure 34833, 34834 Screening Ultrasound 76706 Biopsy During Exploratory Laparotomy 49000 Blood Vessel RepairDirect 35221 With Graft 35281 With Vein Graft 35251 Bypass Graft Removal (Infected) 35907 Catheter (Tunneled)

7 Removal 49422 Celiotomy, See LaparotomyCesarean Section DeliveryDelivery Only 59514, 59620 Delivery With Postpartum Care 59515, 59622 Routine Obstetric Care 59510, 59618 With Hysterectomy 59525 With Tubal Ligation 58611CT ScanWith Contrast 74160, 74174, 74175, 74177, 75635 Without Contrast 74150, 74170, 74176, 74178 DrainageParacentesisWith Imaging Guidance 49083 Without Imaging Guidance 49082 Peripancreatic 48000 Skin and Subcutaneous Tissue 10060, 10061 Ectopic Pregnancy, Surgical Treatment 59130 Excision/DestructionCyst5 cm Diameter or Less cm Diameter 49204 Greater Than cm Diameter 49205 Endometrioma 49203, 49204, 49205 TumorIntraabdominal5 cm or Less cm Diameter 49204 Greater Than cm 49205 Radical Resection5 cm and Greater 22905 Less Than 5 cm 22904 Subcutaneous (Abdominal Wall)3 cm and Greater 22903 Less Than 3 cm 22902 Subfascial (Abdominal Wall)5 cm and Greater 22901 Less Than 5 cm 22900 ExplorationPost-operative Hemorrhage 35840 Preperitoneal Pelvic Packing 49013, 49014 Reopening of Recent Laparotomy 49010 Staging/Restaging 49220, 58960 With or Without Biopsy 49000 Fascia Reinforcement with Nonbiologic or Synthetic Implant 0437 THernia RepairEpigastric 49570, 49572 Inguinal5 Years or Older 49505, 49507, 49520, 49521, 49525 Laparoscopic 49650, 496516 Months to Less Than 5 Years 49500, 49501 Less Than 6 Months of Age 49491, 49492, 49495, 49496 Omphalocele 49600, 49605, 49606, 49610, 49611 Spigelian 49590 Umbilical5 Years or Older 49585, 49587 Less Than 5 Years 49580, 49582 Ventral or Incisional 49560, 49561, 49565, 49566 With Mesh Implantation 49568 Hysterectomy (With or Without Salpingo-oophorectomy)Radical 58210 Supracervical 58180 Total (TAH)

8 58150 Colpourethrocystopexy 58152 Omentectomy 58956 Partial Vaginectomy 58200 With Resection of Ovarian Malignancy 58951, 58953, 58954, 58956 Incision Procedures, See Also LaparotomyDrainage 49020, 49040, 49060, 49062 Exploration 49000, 49010 Paracentesis 49082, 49083 Peritoneal Lavage 49084 Reopening, Recent 49002 Staging/Restaging 49220 With or Without Omentectomy 58960 Injection, Air or Contrast Material 49400 IntraperitonealTunneled CatheterExit Site 49436 Insertion 49418, 49419, 49421, 49435 Removal 49422 Revision 49325 Venous ShuntInsertion 49425 Ligation 49428 Removal 49429 Revision 49426 LaparoscopySurgical 49321, 49322, 49323, 49324, 49325, 49326, 49327 Unlisted Procedure 49329 Without Treatment 49320 Laparotomy, See Also Exploratory Laparotomy, AbdomenReopening, Recent 49002 Staging 49220, 58960 Ligation, Artery 37617 Lymphadenectomy (Removal) 49220 Lymphangiogram/Lymphangiography 75805, 75807 Injection 38790 Magnetic Resonance Imaging (MRI)With Contrast Material 74182 Without Contrast Material 74181 Followed With Contrast Material 74183 Needle Biopsy (Percutaneous) 49180 Nonbiologic or Synthetic Implant 0437 TPanniculectomy, Infraumbilical 15830 ParacentesisWith Imaging Guidance 49083 Without Imaging Guidance 49082 Pelvic Exenteration (Radical Resection) 51597 Peritoneal Venous Shunt Revision 49426 Radiation Therapy Guidance Device Placement 49411, 49412 Radiography/ImagingCT 74150-74178 MRI 74181, 74182, 74183, 74185 Peritoneogram 74190 Ultrasound 76700, 76705X-ray 74018-74022 Removal, Mesh/Prosthetic Material 11008 Suture, Secondary 49900 UltrasoundComplete 76700 Limited 76705 Unlisted Procedure 49999 Wall Debridement for Infection 11005, 11006 Wound (Penetrating) Exploration 20102X-ray, Radiologic Exam 74018-74022 Esophagorrhaphy (Suture)

9 Established Patient, Emergency Department ServicesINDEXCPT is a registered trademark of the American Medical Association. All rights INDEXE sophagorrhaphy (Suture) Established Patient, Emergency Department ServicesEsophagorrhaphy (Suture) 43405, 43410, 43415 EsophagoscopyTransnasalDiagnosticSpecime n Collection 43197 With Biopsy 43198 TransoralAblation Lesion/Polyp/Tumor 43229 Band Ligation Varices 43205 BiopsyNeedle 43232 Single/Multiple 43193, 43198, 43202 Diagnostic 43191, 43200 DilationBalloon 43195, 43214, 43220, 43233 With Ablation, Polyps/Tumors/Other Lesions 43229 With Guidewire Insertion 43196, 43226 With Stent Placement 43212 InjectionDirected, Submucosal 43192, 43201 Sclerosis, Esophageal Varices 43204 Insertion Guidewire 43196, 43212, 43226, 43229 RemovalForeign Body 43194, 43215 Polyp/Tumor/Other Lesions 43216, 43217, 43229 Specimen Collection 43191, 43200 Stent 43212 UltrasoundEndoscopic Examination 43231 Guided Needle Aspiration/Biopsy 43232 With Band Ligation 43205 With Control of Bleeding 43277 With Cricopharyngeal Myotomy 43180 With Diverticulectomy 43180 With Mucosal Resection 43211 With Optical Endomicroscopy 43206 EsophagostomyClosureCervical Approach 43420 Transabdominal Approach 43425 External FistulizationCervical Approach 43352 Thoracic Approach 43351 With Esophagectomy, Total or Partial 43124 Esophagotomy, With Removal of Foreign Body 43020, 43045 Esophagotracheal Fistula, RepairCervical Approach 43305 Thoracic Approach 43312 Congenital Defect 43314 EsophagusAblation, Lesion/Polyp/Tumor 43229 Acid Perfusion (Bernstein)

10 Test 91030 Acid Reflux TestsWith Mucosal Attached Telemetry pH Electrode Analysis 91035 With Nasal CatheterIntraluminal Impedance Electrode Analysis 91037, 91038pH Electrode Analysis 91034 BiopsyEndoscopic, Single or Multiple 43198, 43202 Needle 43232 Forceps, For GERD 3150 FCricopharyngeal Myotomy 43030, 43180 Diagnostic 43200 Dilation 43450, 43453 EndoscopicBalloon 43195, 43214, 43220, 43233 With Ablation, Polyps/Tumors/Other Lesions 43229 With EGD 43248, 43249 With Guidewire Insertion 43196, 43226 With Stent Placement 43212 Surgical, With Permanent Insertion, Transluminal Tube 43510 Endoscopy, See Endoscopy, Esophagus; EsophagoscopyEsophagoscopy, See EsophagoscopyExcisionDiverticulaCervical Approach 43130 Thoracic Approach 43135 Partial 43116, 43117, 43118, 43121, 43124 Total 43107, 43108, 43112, 43113, 43124 Imaging Studies 91110, 91111 Motility 78258 Obstructions/Strictures 74360 Radiologic Examination 74210, 74220, 74221 Reflux 78262 Removal of Foreign Body, via Balloon Catheter 74235 Swallowing Function Cineradiography/Videoradiography 74230 IncisionMuscle, Cricopharyngeal 43030 With Removal of Foreign Body 43020, 43045 InjectionScl