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Chapter 6

Chapter 6 HCPCS, Alpha/Numeric Modifiers, Abbreviations

TermDefinition
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