When services provided were significantly greater than usual for procedure. Not valid
when sole purpose is for a complication due to surgeon’s choice of approach or if to describe a re-operation Documentation MUST BE SUBMITTED WITH CLAIM to support use of this modifier. Otherwise modifier will not be considered. Also, when services were for High Risk Maternity.

Unrelated Evaluation and Management (E&M) by same physician during Post Op Period.

Significant and separately identifiable E&M services by same physician on same day as a procedure. Do not use when E/M services resulted in the decision to perform major surgery or on a surgical code.

Bilateral procedures that are performed at the same operative session.

Multiple procedures, other than the E&M services, performed on the same day or at the same session by the same provider. When billing multiple surgeries the primary procedure (highest Relative Value Unit) should be in the first position.

Discontinued Procedure. Due to extenuating circumstances or those that threaten the well being of the patient, it may be necessary to terminate a surgical or diagnostic procedure.

An evaluation and management service that resulted in the initial decision to perform surgery. Valid for use the day before or day of surgery if the initial decision for surgery was made during the visit.

Staged or related procedure or service during the postoperative period.

Procedure or service was distinct, independent from other services performed on the same day.

Two Surgeons. When more than one surgeon performed a procedure, the modifier should be used by each surgeon to report his/her services.

Repeat services by same physician.

Repeat Procedure by Another Physician - the basic procedure or service performed by another physician had to be repeated.

Return to the Operating Room for a Related Procedure During the Postoperative Period - the procedure or service performed during the postoperative period was related to the original procedure.

Unrelated Procedure or Service by the Same Physician During the Postoperative Period - the procedure or service performed during the postoperative period was unrelated to the original procedure.

Assistant Surgeon. Use same code as primary surgeon.

Reference (Outside) Laboratory - laboratory procedures performed by a party other than the treating or reporting physician.

Repeat Clinical Diagnostic Laboratory Test - same laboratory test repeated on the same day to obtain subsequent (multiple) test results.

Nurse Practitioner, Physician Assistant or Clinical Nurse Specialist Services for Assistant-at-Surgery.

Anatomical Modifiers