Symbols

▲ Revised code
● New code
▶◀ New or revised text
➲ Reference to CPT Assistant, Clinical Examples in Radiology, and
CPT Changes
✚ Add-on code
⃠ Exemptions to modifier 51
⚡ Product pending FDA approval
# Out-of-numerical sequence code
★ Telemedicine
Duplicate PLA test
⇅ Category I PLA

Modifiers (See Appendix A for definitions)

22 Increased Procedural Services
23 Unusual Anesthesia
24 Unrelated Evaluation and Management Service by the Same
Physician or Other Qualified Health Care Professional During a
Postoperative Period
25 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 Service
26 Professional Component
32 Mandated Services
33 Preventive Services
47 Anesthesia by Surgeon
50 Bilateral Procedure
51 Multiple Procedures
52 Reduced Services
53 Discontinued Procedure
54 Surgical Care Only
55 Postoperative Management Only
56 Preoperative Management Only
57 Decision for Surgery
58 Staged or Related Procedure or Service by the Same Physician or
 Other Qualified Health Care Professional During the
Postoperative Period
59 Distinct Procedural Service
62 Two Surgeons
63 Procedure Performed on Infants less than 4 kg
66 Surgical Team
76 Repeat Procedure or Service by Same Physician or Other
Qualified Health Care Professional
77 Repeat Procedure by Another Physician or Other Qualified Health
Care Professional
78 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 Period
79 Unrelated Procedure or Service by the Same Physician or Other
Qualified Health Care Professional During the Postoperative
Period
80 Assistant Surgeon
81 Minimum Assistant Surgeon
82 Assistant Surgeon (when qualified resident surgeon not available)
90 Reference (Outside) Laboratory
91 Repeat Clinical Diagnostic Laboratory Test
92 Alternative Laboratory Platform Testing
95 Synchronous Telemedicine Service Rendered via a Real-Time
Interactive Audio and Video Telecommunications System
96 Habilitative Services
97 Rehabilitative Services
99 Multiple Modifiers

Category II Modifiers
1P Performance Measure Exclusion Modifier due to Medical Reasons
2P Performance Measure Exclusion Modifier due to Patient Reasons
3P Performance Measure Exclusion Modifier due to System Reasons
8P Performance measure reporting modifier–action not performed,
reason not otherwise specified

Anesthesia Physical Status Modifiers

P1 A normal healthy patient
P2 A patient with mild systemic disease
P3 A patient with severe systemic disease
P4 A patient with severe systemic disease that is a constant threat to
life
P5 A moribund patient who is not expected to survive without the
operation
P6 A declared brain-dead patient whose organs are being removed
for donor purposes

Modifiers Approved for Hospital Outpatient

Use
Level I (CPT)
25 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 Service
27 Multiple Outpatient Hospital E/M Encounters on the Same Date
33 Preventive Services
50 Bilateral Procedure
52 Reduced Services
58 Staged or Related Procedure or Service by the Same Physician or
Other Qualified Health Care Professional During the
Postoperative Period
59 Distinct Procedural Service
73 Discontinued Outpatient Procedure Prior to Anesthesia
Administration
74 Discontinued Outpatient Procedure After Anesthesia
Administration
76 Repeat Procedure or Service by Same Physician or Other
Qualified Health Care Professional
77 Repeat Procedure by Another Physician or Other Qualified Health
Care Professional
78 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 Period
79 Unrelated Procedure or Service by the Same Physician or Other
Qualified Health Care Professional During the Postoperative
Period
91 Repeat Clinical Diagnostic Laboratory Test

Level II (HCPCS/National)
LT Left side (used to identify procedures performed on the left side of
the body)
RT Right side (used to identify procedures performed on the right side
of the body)
E1 Upper left, eyelid
E2 Lower left, eyelid
E3 Upper right, eyelid
E4 Lower right, eyelid
FA Left hand, thumb
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
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 same day
LC Left circumflex coronary artery
LD Left anterior descending coronary artery
LM Left main coronary artery
QM Ambulance service provided under arrangement by a provider of
services
QN Ambulance service furnished directly by a provider of services
RC Right coronary artery
RI Ramus intermedius coronary artery
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
Place-of-Service Codes for
Professional Claims
Listed below are place-of-service codes and
descriptions. These codes should be used on
professional claims to specify the entity where
service(s) were rendered. Check with individual
payers (eg, Medicare, Medicaid, other private
insurance) for reimbursement policies regarding
these codes. If you would like to comment on a
code(s) or description(s), please send your request
to [email protected].
Place
of
Service Place of Service
Code(s) Name Place of Service Description
A facility or location where
drugs and other medically
related items and services are
01 Pharmacy
sold, dispensed, or otherwise
provided directly to patients.
(Effective 10/1/03)
02 Telehealth The location where health
services and health related
services are provided or
received, through a
 telecommunication system.
(Effective 1/1/17)
A facility whose primary
03 School
purpose is education.
A facility or location whose
primary purpose is to provide
temporary housing to homeless
04 Homeless Shelter
individuals (eg, emergency
shelters, individual or family
shelters).
A facility or location, owned and
operated by the Indian Health
Service, which provides
Indian Health diagnostic, therapeutic (surgical
05 Service Free- and non-surgical), and
Standing Facility rehabilitation services to
American Indians and Alaska
Natives who do not require
hospitalization.
A facility or location, owned and
operated by the Indian Health
Service, which provides
diagnostic, therapeutic (surgical
Indian Health
and non-surgical), and
06 Service Provider-
rehabilitation services rendered
Based Facility
by, or under the supervision of,
physicians to American Indians
and Alaska Natives admitted as
inpatients or outpatients.
07 Tribal 638 Free- A facility or location owned and
Standing Facility operated by a federally
recognized American Indian or
Alaska Native tribe or tribal
organization under a 638
 agreement, which provides
diagnostic, therapeutic (surgical
and non-surgical), and
rehabilitation services to tribal
members who do not require
hospitalization.
A facility or location owned and
operated by a federally
recognized American Indian or
Alaska Native tribe or tribal
Tribal 638 organization under a 638
08 Provider-Based agreement, which provides
Facility diagnostic, therapeutic (surgical
and non-surgical), and
rehabilitation services to tribal
members admitted as inpatients
or outpatients.
A prison, jail, reformatory, work
farm, detention center, or any
other similar facility maintained
Prison/Correctional by either Federal, State, or local
09
Facility authorities for the purpose of
confinement or rehabilitation of
adult or juvenile criminal
offenders. (Effective 7/1/06)
10 Unassigned N/A
11 Office Location, other than a hospital,
skilled nursing facility (SNF),
military treatment facility,
community health center, State
or local public health clinic, or
intermediate care facility (ICF),
where the health professional
routinely provides health
 examinations, diagnosis, and
treatment of illness or injury on
an ambulatory basis.
Location, other than a hospital
or other facility, where the
12 Home
patient receives care in a
private residence.
Congregate residential facility
with self-contained living units
providing assessment of each
resident’s needs and on-site
Assisted Living support 24 hours a day, 7 days
13
Facility a week, with the capacity to
deliver or arrange for services
including some health care and
other services. (Effective
10/1/03)
A residence, with shared living
areas, where clients receive
supervision and other services
such as social and/or behavioral
14 Group Home
services, custodial service, and
minimal services (eg,
medication administration).
(Effective 10/1/03)
A facility/unit that moves from
place-to-place equipped to
15 Mobile Unit provide preventive, screening,
diagnostic, and/or treatment
services.
16 Temporary A short term accommodation
Lodging such as a hotel, camp ground,
hostel, cruise ship or resort
where the patient receives care,
 and which is not identified by
any other POS code. (Effective
1/1/08)
A walk-in health clinic, other
than an office, urgent care
facility, pharmacy, or
independent clinic, and not
Walk-in Retail described by any other Place of
17
Health Clinic Service code, that is located
within a retail operation and
provides, on an ambulatory
basis, preventive and primary
care services. (Effective 5/1/10)
A location, not described by any
other POS code, owned or
operated by a public or private
entity where the patient is
employed, and where a health
Place of professional provides on-going
18 Employment— or episodic occupational
Worksite medical, therapeutic or
rehabilitative services to the
individual. (This code is
available for use effective
January 1, 2013 but no later
than May 1, 2013.)
19 Off Campus— A portion of an off-campus
Outpatient Hospital hospital provider based
department which provides
diagnostic, therapeutic (both
surgical and nonsurgical), and
rehabilitation services to sick or
injured persons who do not
require hospitalization or
 institutionalization. (Effective
January 1, 2016)
Location, distinct from a hospital
emergency room, an office, or a
clinic, whose purpose is to
Urgent Care diagnose and treat illness or
20
Facility injury for unscheduled,
ambulatory patients seeking
immediate medical attention.
(Effective 1/1/03)
A facility, other than psychiatric,
which primarily provides
diagnostic, therapeutic (both
surgical and non-surgical), and
21 Inpatient Hospital rehabilitation services by, or
under, the supervision of
physicians to patients admitted
for a variety of medical
conditions.
A portion of a hospital’s main
campus which provides
diagnostic, therapeutic (both
surgical and non-surgical), and
On Campus— rehabilitation services to sick or
22
Outpatient Hospital injured persons who do not
require hospitalization or
institutionalization. (Description
change effective January 1,
2016)
A portion of a hospital where
Emergency Room emergency diagnosis and
23
—Hospital treatment of illness or injury is
provided.
24 Ambulatory A free-standing facility, other