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Chapter 6
Chapter 6 HCPCS, Alpha/Numeric Modifiers, Abbreviations
| Term | Definition |
|---|---|
| A Codes | Transportation codes (A0021-A0999), medical and surgical supplies (A4206-A8004), and administrative, miscellaneous and investigational services, equipment, and supplies (A9150-A9999) |
| B Codes | Enteral and parenteral therapy (B4000-B9999) |
| C Codes | Temporary codes for use with Outpatient Prospective Payment System (OPPS) (pass through) (C1300-C9899) |
| E Codes | Durable Medical Equipment (E0100-E8002) |
| G Codes | Procedures /professional services (temporary) (G0008-G9156) |
| H Codes | Temporary national codes for governmental entities other than Medicare (H0001-H2037) |
| J Codes | Drugs administered other than oral method (J0120-J8499) and Chemotherapy drugs (J8501-J9999) |
| K Codes | Assigned to DME MAC (K0000-K0899) |
| L Codes | Orthotic procedures and devices (L0000-L4999) and prosthetic procedures (L5000-L9900) |
| M Codes | Medical Services (M0000-M0301) |
| P Codes | Pathology and Laboratory Services (P0000-P9999) |
| Q Codes | Procedures, Services, and supplies on a temporary basis (Q0035-Q9968) |
| R Codes | Diagnostic radiology services (R0000-R9999) |
| S Codes | Temporarily national codes (non Medicare) (S0000-S9999) |
| T Codes | National codes established for state Medicaid agencies (T1000-T9999) |
| V Codes | Vision Services (V0000-V2999) and hearing, which also includes speech-language pathology service (V5000-V5999) |
| IA | Intra-arterial Administration - Administration of the drug is given within an artery. |
| IV | Intravenous administration - Administration of the drug is given into the vein. |
| IM | Intramuscular administration - Administration of the drug via an injection into a muscle. |
| IT | Intrathecal - Administration of the drug is given into the subdural space of the spinal cord. |
| SC | Subcutaneous administration - Administration of the drug via an injection just under the skin. |
| INH | Administration by inhaled solution - Administration of the drug by breathing it. |
| VAR | Various routes of administration - Administration of the drug by various routes commonly administered into joints, cavities, tissues, or topical applications |
| OTH | Other routes of administration - other administration methods like suppositories or catheter injections. |
| ORAL | Administered orally - Administration of the drug via taking it by mouth. |
| Medicare Carriers Manual (MCM) References | Includes the Coverage Issue Manual (CIM) references, the Medicare Carriers Manual references contain CMS regulations and rulings concerning coverage procedures, services, and supplies. |
| Medicare Statutes | The appendix covers statutory coverage issues (eg, 1862 [42 U.S.C. 1395y] (a)(1)(A)-(21), Exclusions from coverage and Medicare as Secondary Payer). |
| E1 | Upper left, eyelid |
| F5 | Right hand, thumb |
| ET | Emergency services |
| GM | Multiple patients on one ambulance trip |
| HF | Substance abuse program |
| RC | Right coronary artery |
| Q6 | Service furnished by a locum tenens physician |
| D | Diagnostic or therapeutic site other then "P" or "H" when these codes are used as origin codes |
| E | Residential, domiciliary, custodial facility (other than an 1819 facility) |
| G | Hospital-based ESRD facility (hospital or hospital related) |
| H | Hospital |
| I | Site of transfer (eg. airport or helicopter pad between modes of ambulance transport) |
| J | Freestanding ESRD facility |
| N | Skilled nursing facility (SNF) (1819 facility) |
| P | Physician's office |
| R | Residence |
| S | Scene of accident or acute event |
| X | (Destination code only) Intermediate stop at physician's office on the way to the hospital. |
| HH | Ambulance trip from discharge/transfer from one hospital to another hospital |
| RH | Ambulance trip from the patient's residence to a hospital |
| SH | Ambulance trip from scene of accident to a hospital |
| RP | Ambulance trip from the patient's residence to a physician's office |
| Transportation Services including Ambulance For Ground | Basic life support (BLS); Advanced life support, Level 1 (ALS1); Advanced life support, Level 2 (ALS2); Specialty care transport (SCT); Paramedic ALS intercept (P1) |
| Transportation Services including Ambulance For AIR | Fixed wing air ambulance (FW); Rotary wing air ambulance (RW) |
| A0422 | Ambulance (ALS or BLS) oxygen and oxygen supplies, life-sustaining situation. |
| A0433 | Advanced life support, level 2 (ALS2) |
| A0434 | Specialty care transport (SCT) |
| 22 | Increased Procedural Service |
| 23 | Unusual Anesthesia |
| 24 | Unrelated E/M by the same Physician or Other qualified healthcare professional during a postoperative period |
| 25 | Significant, Separately Identifiable E/M service by the same Physician or Other Qualified Healthcare Professional on the same date of the procedure or other service. |
| 26 | Professional Component |
| 32 | Mandated Service |
| 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 healthcare professional during the postoperative period. |
| 59 | Dental 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 healthcare professional |
| 77 | Repeat procedure by Another Physician or Other Qualified Healthcare Professional. |
| 78 | Unplanned Return to the Operating/Procedure Room by the Same Physician or Other Qualified Healthcare Professional Following Initial Procedure for a Related Procedure During the Postoperative period. |
| 79 | Unrelated Procedure/Service by the Same Physician or Other qualified healthcare professional during the postoperative period |
| 80 | Assistant Surgeon |
| 81 | Minimum Assistant Surgeon |
| 82 | Assistant Surgeon (when qualified resident surgeon not available) |
| 90 | Reference (Outside) Labratory |
| 91 | Repeat Clinical Diagnostic Laboratory Test |
| 92 | Alternative Laboratory Platform Testing |
| 99 | Multiple Modifiers |
| BO | Orally Administered Nutrition, Not by feeding tube |
| E2 | Lower Left Eyelid |
| F1 | Left Hand, Second Digit |
| GA | Waiver of Liability Statement Issued as a Required by Payer, Policy, Individual Case |
| GU | Waiver of Liability Statement Issued as a Required by Payer Policy, Routine Notice |
| LT | Left Side |
| NU | New Equipment |
| Q6 | Service Furnished by a Locum Tenens Physician |
| TC | Technical Component |
Created by:
BBracha
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