"MODIFIER","LO_VERSION","HI_VERSION","DESCRIPTION","DATE_ACTIVATED","NCCI","THERAPY","NON_DISCOUNT","DIED_TRANSFERRED","DEVICE_REQ_EXCLUSION"
"1P","63","69","Not Available","0","0","0","0","0","0"
"22","63","90","Unusual procedural services","0","0","0","0","0","0"
"23","63","90","Unusual anesthesia","0","0","0","0","0","0"
"24","63","90","Unrelated e&m same md postop","0","1","0","0","0","0"
"25","63","90","Sig sep iden e&m same md/day","0","1","0","0","0","0"
"26","63","90","Professional component","0","0","0","0","0","0"
"27","63","90","Mult outpat e/m enc samedate","0","1","0","0","0","0"
"2P","63","69","Not Available","0","0","0","0","0","0"
"32","63","90","Mandated services","0","0","0","0","0","0"
"33","63","90","Preventive services","0","0","0","0","0","0"
"3P","63","69","Not Available","0","0","0","0","0","0"
"47","63","90","Anesthesia by surgeon","0","0","0","0","0","0"
"50","63","90","Bilateral procedure","0","0","0","0","0","0"
"51","63","90","Multiple procedures","0","0","0","0","0","0"
"52","63","90","Reduced services","0","0","0","0","0","1"
"53","63","90","Discontinued procedure","0","0","0","0","0","0"
"54","63","90","Surgical care only","0","0","0","0","0","0"
"55","63","90","Postoperative managemnt only","0","0","0","0","0","0"
"56","63","90","Preoperative management only","0","0","0","0","0","0"
"57","63","90","Decision for surgery","0","1","0","0","0","0"
"58","63","90","Staged/rel proc sm md postop","0","1","0","0","0","0"
"59","63","90","Distinct procedural service","0","1","0","0","0","0"
"62","63","90","Two surgeons","0","0","0","0","0","0"
"63","63","90","Proc perform on infants <4kg","0","0","0","0","0","0"
"66","63","90","Surgical team","0","0","0","0","0","0"
"73","63","90","Proc discntd prior to anes","0","0","0","0","0","1"
"74","63","90","Proc discntd after anesth","0","0","0","0","0","1"
"76","63","90","Repeat procedure by same md","0","0","0","1","0","0"
"77","63","90","Repeat procedure another md","0","0","0","1","0","0"
"78","63","90","Return to or rel svc postop","0","1","0","1","0","0"
"79","63","90","Unrel proc/svc sm md postop","0","1","0","1","0","0"
"80","63","90","Assistant surgeon","0","0","0","0","0","0"
"81","63","90","Minimum assistant surgeon","0","0","0","0","0","0"
"82","63","90","Asst surgeon (res not avail)","0","0","0","0","0","0"
"8P","63","90","Performance modifier nos","0","0","0","0","0","0"
"90","63","90","Reference (outside) lab","0","0","0","0","0","0"
"91","63","90","Repeat clincl diag lab test","0","1","0","0","0","0"
"92","63","90","Alt lab platform testing","0","0","0","0","0","0"
"93","86","90","Sync telemed svc audio only","0","0","0","0","0","0"
"95","66","90","Synchronous telemed svc","0","0","0","0","0","0"
"96","70","90","Habilitative services","0","0","0","0","0","0"
"97","70","90","Rehabilitative services","0","0","0","0","0","0"
"99","63","90","Multiple modifiers","0","0","0","0","0","0"
"A1","63","90","Dressing for one wound","0","0","0","0","0","0"
"A2","63","90","Dressing for two wounds","0","0","0","0","0","0"
"A3","63","90","Dressing for three wounds","0","0","0","0","0","0"
"A4","63","90","Dressing for four wounds","0","0","0","0","0","0"
"A5","63","90","Dressing for five wounds","0","0","0","0","0","0"
"A6","63","90","Dressing for six wounds","0","0","0","0","0","0"
"A7","63","90","Dressing for seven wounds","0","0","0","0","0","0"
"A8","63","90","Dressing for eight wounds","0","0","0","0","0","0"
"A9","63","90","Dressing for 9 or more wound","0","0","0","0","0","0"
"AA","63","90","Anesthesia perf by anesgst","0","0","0","0","0","0"
"AB","90","90","Aud svs w/o order evry 12mo","0","0","0","0","0","0"
"AD","63","90","Md supervision, >4 anes proc","0","0","0","0","0","0"
"AE","63","90","Registered dietician","0","0","0","0","0","0"
"AF","63","90","Specialty physician","0","0","0","0","0","0"
"AG","63","90","Primary physician","0","0","0","0","0","0"
"AH","63","90","Clinical psychologist","0","0","0","0","0","0"
"AI","63","90","Principal physician of rec","0","0","0","0","0","0"
"AJ","63","90","Clinical social worker","0","0","0","0","0","0"
"AK","63","90","Non participating physician","0","0","0","0","0","0"
"AM","63","90","Physician, team member svc","0","0","0","0","0","0"
"AO","63","90","Prov declined alt pmt method","0","0","0","0","0","0"
"AP","63","90","No dtmn of refractive state","0","0","0","0","0","0"
"AQ","63","90","Physician service hpsa area","0","0","0","0","0","0"
"AR","63","90","Physician scarcity area","0","0","0","0","0","0"
"AS","63","90","Assistant at surgery service","0","0","0","0","0","0"
"AT","63","90","Acute treatment","0","0","0","0","0","0"
"AU","63","90","Uro, ostomy or trach item","0","0","0","0","0","0"
"AV","63","90","Item w prosthetic/orthotic","0","0","0","0","0","0"
"AW","63","90","Item w a surgical dressing","0","0","0","0","0","0"
"AX","63","90","Item w dialysis services","0","0","0","0","0","0"
"AY","63","90","Item/service not for esrd tx","0","0","0","0","0","0"
"AZ","63","90","Physician serv in dent hpsa","0","0","0","0","0","0"
"BA","63","90","Item w pen services","0","0","0","0","0","0"
"BL","63","90","Spec acquisition blood prods","0","0","0","0","0","0"
"BO","63","90","Nutrition oral admin no tube","0","0","0","0","0","0"
"BP","63","90","Bene electd to purchase item","0","0","0","0","0","0"
"BR","63","90","Bene elected to rent item","0","0","0","0","0","0"
"BU","63","90","Bene undecided on purch/rent","0","0","0","0","0","0"
"CA","63","90","Procedure payable inpatient","0","0","0","0","1","0"
"CB","63","90","Esrd bene part a snf-sep pay","0","0","0","0","0","0"
"CC","63","90","Procedure code change","0","0","0","0","0","0"
"CD","63","90","Amcc test for esrd or mcp md","0","0","0","0","0","0"
"CE","63","90","Med neces amcc tst sep reimb","0","0","0","0","0","0"
"CF","63","90","Amcc tst not composite rate","0","0","0","0","0","0"
"CG","63","90","Policy criteria applied","0","0","0","0","0","0"
"CH","63","90","0 percent impaired, ltd, res","0","0","0","0","0","0"
"CI","63","90","1 to <20 percent impaired","0","0","0","0","0","0"
"CJ","63","90","20 to <40 percent impaired","0","0","0","0","0","0"
"CK","63","90","40 to <60 percent impaired","0","0","0","0","0","0"
"CL","63","90","60 to <80 percent impaired","0","0","0","0","0","0"
"CM","63","90","80 to <100 percent impaired","0","0","0","0","0","0"
"CN","63","90","100 percent impaired, ltd","0","0","0","0","0","0"
"CO","74","90","Outpatient ot service by ota","0","0","0","0","0","0"
"CP","63","69","C-apc adjunctive service","0","0","0","0","0","0"
"CQ","74","90","Outpatient pt service by pta","0","0","0","0","0","0"
"CR","63","90","Catastrophe/disaster related","0","0","0","0","0","0"
"CS","63","77","Gulf oil 2010 spill related","0","0","0","0","0","0"
"CS","78","90","Cost share waiver covid-19","0","0","0","0","0","0"
"CT","63","90","Ct does not meet nema standa","0","0","0","0","0","0"
"DA","63","90","Oral health assess, not dent","0","0","0","0","0","0"
"E1","63","90","Upper left eyelid","0","1","0","0","0","0"
"E2","63","90","Lower left eyelid","0","1","0","0","0","0"
"E3","63","90","Upper right eyelid","0","1","0","0","0","0"
"E4","63","90","Lower right eyelid","0","1","0","0","0","0"
"EA","63","90","Esa, anemia, chemo-induced","0","0","0","0","0","0"
"EB","63","90","Esa, anemia, radio-induced","0","0","0","0","0","0"
"EC","63","90","Esa, anemia, non-chemo/radio","0","0","0","0","0","0"
"ED","63","90","Hct>39% or hgb>13g>=3 cycle","0","0","0","0","0","0"
"EE","63","90","Hct>39% or hgb>13g<3 cycle","0","0","0","0","0","0"
"EJ","63","90","Subsequent claim","0","0","0","0","0","0"
"EM","63","90","Emer reserve supply (esrd)","0","0","0","0","0","0"
"EP","63","90","Medicaid epsdt program svc","0","0","0","0","0","0"
"ER","74","90","Off-campus ed service","0","0","0","0","0","0"
"ET","63","90","Emergency services","0","0","0","0","0","0"
"EX","63","90","Expatriate beneficiary","0","0","0","0","0","0"
"EY","63","90","No md order for item/service","0","0","0","0","0","0"
"F1","63","90","Left hand, second digit","0","1","0","0","0","0"
"F2","63","90","Left hand, third digit","0","1","0","0","0","0"
"F3","63","90","Left hand, fourth digit","0","1","0","0","0","0"
"F4","63","90","Left hand, fifth digit","0","1","0","0","0","0"
"F5","63","90","Right hand, thumb","0","1","0","0","0","0"
"F6","63","90","Right hand, second digit","0","1","0","0","0","0"
"F7","63","90","Right hand, third digit","0","1","0","0","0","0"
"F8","63","90","Right hand, fourth digit","0","1","0","0","0","0"
"F9","63","90","Right hand, fifth digit","0","1","0","0","0","0"
"FA","63","90","Left hand, thumb","0","1","0","0","0","0"
"FB","63","90","Item provided without cost","0","0","0","0","0","0"
"FC","63","90","Part credit, replaced device","0","0","0","0","0","0"
"FP","63","90","Svc part of family plan pgm","0","0","0","0","0","0"
"FQ","86","90","Audio-only service","0","0","0","0","0","0"
"FR","86","90","Two-way a/v dir supervision","0","0","0","0","0","0"
"FS","86","90","Split or shared e/m visit","0","0","0","0","0","0"
"FT","86","90","Separate, unrelated e/m","0","0","0","0","0","0"
"FX","66","90","X-ray taken using film","0","0","0","0","0","0"
"FY","70","90","Computed radiography x-ray","0","0","0","0","0","0"
"G0","74","90","Telestroke","0","0","0","0","0","0"
"G1","63","90","Urr reading of less than 60","0","0","0","0","0","0"
"G2","63","90","Urr reading of 60 to 64.9","0","0","0","0","0","0"
"G3","63","90","Urr reading of 65 to 69.9","0","0","0","0","0","0"
"G4","63","90","Urr reading of 70 to 74.9","0","0","0","0","0","0"
"G5","63","90","Urr reading of 75 or greater","0","0","0","0","0","0"
"G6","63","90","Esrd patient <6 dialysis/mth","0","0","0","0","0","0"
"G7","63","90","Payment limits do not apply","0","0","0","0","0","0"
"G8","63","90","Monitored anesthesia care","0","0","0","0","0","0"
"G9","63","90","Mac for at risk patient","0","0","0","0","0","0"
"GA","63","90","Liability waiver ind case","0","0","0","0","0","0"
"GB","63","90","Claim resubmitted","0","0","0","0","0","0"
"GC","63","90","Resident/teaching phys serv","0","0","0","0","0","0"
"GD","63","77","Unit of service > mue value","0","0","0","0","0","0"
"GE","63","90","Resident prim care exception","0","0","0","0","0","0"
"GF","63","90","Nonphysician serv c a hosp","0","0","0","0","0","0"
"GG","63","90","Payment screen mam + diagmam","0","0","0","0","0","0"
"GH","63","90","Diag mammo to screening mamo","0","0","0","0","0","0"
"GJ","63","90","Opt out provider of er srvc","0","0","0","0","0","0"
"GK","63","90","Actual item/service ordered","0","0","0","0","0","0"
"GL","63","90","Upgraded item, no charge","0","0","0","0","0","0"
"GM","63","90","Multiple transports","0","0","0","0","0","0"
"GN","63","90","Op speech language service","0","0","1","0","0","0"
"GO","63","90","Op occupational therapy serv","0","0","1","0","0","0"
"GP","63","90","Op pt services","0","0","1","0","0","0"
"GQ","63","90","Telehealth store and forward","0","0","0","0","0","0"
"GR","63","90","Service by va resident","0","0","0","0","0","0"
"GS","63","90","Epo/darbepoietin reduced 25%","0","0","0","0","0","0"
"GT","63","90","Interactivetelecommunication","0","0","0","0","0","0"
"GU","63","90","Liability waiver rout notice","0","0","0","0","0","0"
"GV","63","90","Attending phys not hospice","0","0","0","0","0","0"
"GW","63","90","Service unrelated to term co","0","0","0","0","0","0"
"GX","63","90","Voluntary liability notice","0","0","0","0","0","0"
"GY","63","90","Statutorily excluded","0","0","0","0","0","0"
"GZ","63","90","Not reasonable and necessary","0","0","0","0","0","0"
"H9","63","90","Court-ordered","0","0","0","0","0","0"
"HA","63","90","Child/adolescent program","0","0","0","0","0","0"
"HB","63","90","Adult program non-geriatric","0","0","0","0","0","0"
"HC","63","90","Adult program geriatric","0","0","0","0","0","0"
"HD","63","90","Pregnant/parenting program","0","0","0","0","0","0"
"HE","63","90","Mental health program","0","0","0","0","0","0"
"HF","63","90","Substance abuse program","0","0","0","0","0","0"
"HG","63","90","Opioid addiction tx program","0","0","0","0","0","0"
"HH","63","90","Mental hlth/substance abs pr","0","0","0","0","0","0"
"HI","63","90","Men hlth intel/dev disab pgm","0","0","0","0","0","0"
"HJ","63","90","Employee assistance program","0","0","0","0","0","0"
"HK","63","90","Spec hgh rsk mntl hlth pop p","0","0","0","0","0","0"
"HL","63","90","Intern","0","0","0","0","0","0"
"HM","63","90","Less than bachelor degree lv","0","0","0","0","0","0"
"HN","63","90","Bachelors degree level","0","0","0","0","0","0"
"HO","63","90","Masters degree level","0","0","0","0","0","0"
"HP","63","90","Doctoral level","0","0","0","0","0","0"
"HQ","63","90","Group setting","0","0","0","0","0","0"
"HR","63","90","Family/couple w client prsnt","0","0","0","0","0","0"
"HS","63","90","Family/couple w/o client prs","0","0","0","0","0","0"
"HT","63","90","Multi-disciplinary team","0","0","0","0","0","0"
"HU","63","90","Child welfare agency funded","0","0","0","0","0","0"
"HV","63","90","Funded state addiction agncy","0","0","0","0","0","0"
"HW","63","90","State mntl hlth agncy funded","0","0","0","0","0","0"
"HX","63","90","County/local agency funded","0","0","0","0","0","0"
"HY","63","90","Funded by juvenile justice","0","0","0","0","0","0"
"HZ","63","90","Criminal justice agncy fund","0","0","0","0","0","0"
"J1","63","90","Cap no-pay for prescript num","0","0","0","0","0","0"
"J2","63","90","Cap restock of emerg drugs","0","0","0","0","0","0"
"J3","63","90","Cap drug unavail thru cap","0","0","0","0","0","0"
"J4","63","90","Dmepos comp bid furn by hosp","0","0","0","0","0","0"
"J5","81","90","Dmepos comp bid fur by pt/ot","0","0","0","0","0","0"
"JA","63","90","Administered intravenously","0","0","0","0","0","0"
"JB","63","90","Administered subcutaneously","0","0","0","0","0","0"
"JC","63","90","Skin substitute graft","0","0","0","0","0","0"
"JD","63","90","Skin sub not used as a graft","0","0","0","0","0","0"
"JE","63","90","Administered via dialysate","0","0","0","0","0","0"
"JG","70","90","340b acquired drug","0","0","0","0","0","0"
"JW","63","90","Discarded drug not administe","0","0","0","0","0","0"
"JZ","90","90","Zero drug wasted","0","0","0","0","0","0"
"K0","63","90","Lwr ext prost functnl lvl 0","0","0","0","0","0","0"
"K1","63","90","Lwr ext prost functnl lvl 1","0","0","0","0","0","0"
"K2","63","90","Lwr ext prost functnl lvl 2","0","0","0","0","0","0"
"K3","63","90","Lwr ext prost functnl lvl 3","0","0","0","0","0","0"
"K4","63","90","Lwr ext prost functnl lvl 4","0","0","0","0","0","0"
"KA","63","90","Wheelchair add-on option/acc","0","0","0","0","0","0"
"KB","63","90",">4 modifiers on claim","0","0","0","0","0","0"
"KC","63","90","Repl special pwr wc intrface","0","0","0","0","0","0"
"KD","63","90","Drug/biological dme infused","0","0","0","0","0","0"
"KE","63","90","Bid under round 1 dmepos cb","0","0","0","0","0","0"
"KF","63","90","Fda class iii device","0","0","0","0","0","0"
"KG","63","90","Dmepos comp bid prgm no 1","0","0","0","0","0","0"
"KH","63","90","Dmepos ini clm, pur/1 mo rnt","0","0","0","0","0","0"
"KI","63","90","Dmepos 2nd or 3rd mo rental","0","0","0","0","0","0"
"KJ","63","90","Dmepos pen pmp or 4-15mo rnt","0","0","0","0","0","0"
"KK","63","90","Dmepos comp bid prgm no 2","0","0","0","0","0","0"
"KL","63","90","Dmepos mailorder comp bid","0","0","0","0","0","0"
"KM","63","90","Rplc facial prosth new imp","0","0","0","0","0","0"
"KN","63","90","Rplc facial prosth old mod","0","0","0","0","0","0"
"KO","63","90","Single drug unit dose form","0","0","0","0","0","0"
"KP","63","90","First drug of multi drug u d","0","0","0","0","0","0"
"KQ","63","90","2nd/subsqnt drg multi drg ud","0","0","0","0","0","0"
"KR","63","90","Rental item partial month","0","0","0","0","0","0"
"KS","63","90","Glucose monitor supply","0","0","0","0","0","0"
"KT","63","90","Item from noncontract supply","0","0","0","0","0","0"
"KU","63","90","Dmepos comp bid prgm no 3","0","0","0","0","0","0"
"KV","63","90","Dmepos item, profession serv","0","0","0","0","0","0"
"KW","63","90","Dmepos comp bid prgm no 4","0","0","0","0","0","0"
"KX","63","90","Documentation on file","0","0","0","0","0","0"
"KY","63","90","Dmepos comp bid prgm no 5","0","0","0","0","0","0"
"KZ","63","90","New cov not implement by m+c","0","0","0","0","0","0"
"L1","63","65","Separately payable lab test","0","0","0","0","0","0"
"LC","63","90","Lft circum coronary artery","0","1","0","0","0","0"
"LD","63","90","Left ant des coronary artery","0","1","0","0","0","0"
"LL","63","90","Lease/rental (appld to pur)","0","0","0","0","0","0"
"LM","63","90","Left main coronary artery","0","1","0","0","0","0"
"LR","63","90","Laboratory round trip","0","0","0","0","0","0"
"LS","63","90","Fda-monitored iol implant","0","0","0","0","0","0"
"LT","63","90","Left side","0","1","0","0","0","0"
"LU","86","90","Fraction pay car-t therapy","0","0","0","0","0","0"
"M2","63","90","Medicare secondary payer","0","0","0","0","0","0"
"MA","78","90","Emer med cond susp/confirm","0","0","0","0","0","0"
"MB","78","90","Auc hardship, insuf internet","0","0","0","0","0","0"
"MC","78","90","Auc hardship, vendor issues","0","0","0","0","0","0"
"MD","78","90","Auc hardship, extreme circ","0","0","0","0","0","0"
"ME","78","90","Order adheres to auc","0","0","0","0","0","0"
"MF","78","90","Order does not adhere to auc","0","0","0","0","0","0"
"MG","78","90","Auc not applicable to order","0","0","0","0","0","0"
"MH","78","90","Auc consult not provided","0","0","0","0","0","0"
"MS","63","90","6-mo maint/svc fee parts/lbr","0","0","0","0","0","0"
"N1","90","90","Group 1 oxygen cov crit met","0","0","0","0","0","0"
"N2","90","90","Group 2 oxygen cov crit met","0","0","0","0","0","0"
"N3","90","90","Group 3 oxygen cov crit met","0","0","0","0","0","0"
"NB","63","90","Drug specific nebulizer","0","0","0","0","0","0"
"NR","63","90","New when rented","0","0","0","0","0","0"
"NU","63","90","New equipment","0","0","0","0","0","0"
"P1","63","90","Normal healthy patient","0","0","0","0","0","0"
"P2","63","90","Patient w/mild syst disease","0","0","0","0","0","0"
"P3","63","90","Patient w/severe sys disease","0","0","0","0","0","0"
"P4","63","90","Pt w/sev sys dis threat life","0","0","0","0","0","0"
"P5","63","90","Pt not expect surv w/o oper","0","0","0","0","0","0"
"P6","63","90","Brain-dead pt organs removed","0","0","0","0","0","0"
"PA","63","90","Surgery, wrong body part","0","0","0","0","0","0"
"PB","63","90","Surgery, wrong patient","0","0","0","0","0","0"
"PC","63","90","Wrong surgery on patient","0","0","0","0","0","0"
"PD","63","90","Inp admit w/in 3 days","0","0","0","0","0","0"
"PI","63","90","Pet tumor init tx strat","0","0","0","0","0","0"
"PL","63","90","Progressive addition lenses","0","0","0","0","0","0"
"PM","63","90","Post mortem","0","0","0","0","0","0"
"PN","66","90","Non-excepted off-campus svc","0","0","0","0","0","0"
"PO","63","90","Excepted off-campus service","0","0","0","0","0","0"
"PS","63","90","Pet tumor subsq tx strategy","0","0","0","0","0","0"
"PT","63","90","Clrctal screen to diagn","0","0","0","0","0","0"
"Q0","63","90","Invest clinical research","0","0","0","0","0","0"
"Q1","63","90","Routine clinical research","0","0","0","0","0","0"
"Q2","63","90","Demo procedure, service","0","0","0","0","0","0"
"Q3","63","90","Live donor surgery/services","0","0","0","0","0","0"
"Q4","63","90","Svc exempt - ordrg/rfrng md","0","0","0","0","0","0"
"Q5","63","90","Recip bill arr subs md or pt","0","0","0","0","0","0"
"Q6","63","90","Fee/time comp subst md or pt","0","0","0","0","0","0"
"Q7","63","90","One class a finding","0","0","0","0","0","0"
"Q8","63","90","Two class b findings","0","0","0","0","0","0"
"Q9","63","90","1 class b & 2 class c fndngs","0","0","0","0","0","0"
"QA","71","90","Avg sta day/night o2 < 1 lpm","0","0","0","0","0","0"
"QB","71","90","Avg day/nite o2 > 4 lpm/port","0","0","0","0","0","0"
"QC","63","90","Single channel monitoring","0","0","0","0","0","0"
"QD","63","90","Rcrdg/strg in sld st memory","0","0","0","0","0","0"
"QE","63","90","Stationary o2 @ rest <1 lpm","0","0","0","0","0","0"
"QF","63","90","Station o2 @ rest >4lpm/port","0","0","0","0","0","0"
"QG","63","90","Station o2 @ rest > 4 lpm","0","0","0","0","0","0"
"QH","63","90","Oxygen cnsrvg dvc w del sys","0","0","0","0","0","0"
"QJ","63","90","Patient in state/locl custod","0","0","0","0","0","0"
"QK","63","90","Med dir 2-4 cncrnt anes proc","0","0","0","0","0","0"
"QL","63","90","Patient died after amb call","0","0","0","0","0","0"
"QM","63","90","Ambulance arr by provider","0","0","0","0","0","0"
"QN","63","90","Ambulance furn by provider","0","0","0","0","0","0"
"QP","63","90","Individually ordered lab tst","0","0","0","0","0","0"
"QQ","72","90","Qualified cdsm consulted","0","0","0","0","0","0"
"QR","71","90","Avg sta day/night o2 > 4 lpm","0","0","0","0","0","0"
"QS","63","90","Monitored anesthesia care","0","0","0","0","0","0"
"QT","63","90","Rcrdg/strg tape analog recdr","0","0","0","0","0","0"
"QW","63","90","Clia waived test","0","0","0","0","0","0"
"QX","63","90","Crna svc w/ md med direction","0","0","0","0","0","0"
"QY","63","90","Medically directed crna","0","0","0","0","0","0"
"QZ","63","90","Crna svc w/o med dir by md","0","0","0","0","0","0"
"RA","63","90","Replacement of dme item","0","0","0","0","0","0"
"RB","63","90","Replacement part, dme item","0","0","0","0","0","0"
"RC","63","90","Right coronary artery","0","1","0","0","0","0"
"RD","63","90","Drug admin not incident-to","0","0","0","0","0","0"
"RE","63","90","Furnish full compliance rems","0","0","0","0","0","0"
"RI","63","90","Ramus intermedius cor artery","0","1","0","0","0","0"
"RR","63","90","Rental (dme)","0","0","0","0","0","0"
"RT","63","90","Right side","0","1","0","0","0","0"
"SA","63","90","Nurse practitioner w physici","0","0","0","0","0","0"
"SB","63","90","Nurse midwife","0","0","0","0","0","0"
"SC","63","90","Medically necessary serv/sup","0","0","0","0","0","0"
"SD","63","90","Serv by home infusion rn","0","0","0","0","0","0"
"SE","63","90","State/fed funded program/ser","0","0","0","0","0","0"
"SF","63","90","2nd opinion ordered by pro","0","0","0","0","0","0"
"SG","63","90","Asc facility service","0","0","0","0","0","0"
"SH","63","90","2nd concurrent infusion ther","0","0","0","0","0","0"
"SJ","63","90","3rd concurrent infusion ther","0","0","0","0","0","0"
"SK","63","90","High risk population","0","0","0","0","0","0"
"SL","63","90","State supplied vaccine","0","0","0","0","0","0"
"SM","63","90","Second opinion","0","0","0","0","0","0"
"SN","63","90","Third opinion","0","0","0","0","0","0"
"SQ","63","90","Item ordered by home health","0","0","0","0","0","0"
"SS","63","90","Hit in infusion suite","0","0","0","0","0","0"
"ST","63","90","Related to trauma or injury","0","0","0","0","0","0"
"SU","63","90","Performed in phys office","0","0","0","0","0","0"
"SV","63","90","Drugs delivered not used","0","0","0","0","0","0"
"SW","63","90","Serv by cert diab educator","0","0","0","0","0","0"
"SY","63","90","Contact w/high-risk pop","0","0","0","0","0","0"
"SZ","63","69","Habilitative services","0","0","0","0","0","0"
"T1","63","90","Left foot, second digit","0","1","0","0","0","0"
"T2","63","90","Left foot, third digit","0","1","0","0","0","0"
"T3","63","90","Left foot, fourth digit","0","1","0","0","0","0"
"T4","63","90","Left foot, fifth digit","0","1","0","0","0","0"
"T5","63","90","Right foot, great toe","0","1","0","0","0","0"
"T6","63","90","Right foot, second digit","0","1","0","0","0","0"
"T7","63","90","Right foot, third digit","0","1","0","0","0","0"
"T8","63","90","Right foot, fourth digit","0","1","0","0","0","0"
"T9","63","90","Right foot, fifth digit","0","1","0","0","0","0"
"TA","63","90","Left foot, great toe","0","1","0","0","0","0"
"TB","70","89","Tracking 340b acquired drug","0","0","0","0","0","0"
"TB","90","90","340b drug: slct entities","0","0","0","0","0","0"
"TC","63","90","Technical component","0","0","0","0","0","0"
"TD","63","90","Rn","0","0","0","0","0","0"
"TE","63","90","Lpn/lvn","0","0","0","0","0","0"
"TF","63","90","Intermediate level of care","0","0","0","0","0","0"
"TG","63","90","Complex/high tech level care","0","0","0","0","0","0"
"TH","63","90","Ob tx/srvcs prenatl/postpart","0","0","0","0","0","0"
"TJ","63","90","Child/adolescent program gp","0","0","0","0","0","0"
"TK","63","90","Extra patient or passenger","0","0","0","0","0","0"
"TL","63","90","Early intervention ifsp","0","0","0","0","0","0"
"TM","63","90","Individualized ed prgrm(iep)","0","0","0","0","0","0"
"TN","63","90","Rural/out of service area","0","0","0","0","0","0"
"TP","63","90","Med transprt unloaded vehicl","0","0","0","0","0","0"
"TQ","63","90","Bls by volunteer amb providr","0","0","0","0","0","0"
"TR","63","90","School-based iep out of dist","0","0","0","0","0","0"
"TS","63","90","Follow-up service","0","0","0","0","0","0"
"TT","63","90","Additional patient","0","0","0","0","0","0"
"TU","63","90","Overtime payment rate","0","0","0","0","0","0"
"TV","63","90","Holiday/weekend payment rate","0","0","0","0","0","0"
"TW","63","90","Back-up equipment","0","0","0","0","0","0"
"U1","63","90","M/caid care lev 1 state def","0","0","0","0","0","0"
"U2","63","90","M/caid care lev 2 state def","0","0","0","0","0","0"
"U3","63","90","M/caid care lev 3 state def","0","0","0","0","0","0"
"U4","63","90","M/caid care lev 4 state def","0","0","0","0","0","0"
"U5","63","90","M/caid care lev 5 state def","0","0","0","0","0","0"
"U6","63","90","M/caid care lev 6 state def","0","0","0","0","0","0"
"U7","63","90","M/caid care lev 7 state def","0","0","0","0","0","0"
"U8","63","90","M/caid care lev 8 state def","0","0","0","0","0","0"
"U9","63","90","M/caid care lev 9 state def","0","0","0","0","0","0"
"UA","63","90","M/caid care lev 10 state def","0","0","0","0","0","0"
"UB","63","90","M/caid care lev 11 state def","0","0","0","0","0","0"
"UC","63","90","M/caid care lev 12 state def","0","0","0","0","0","0"
"UD","63","90","M/caid care lev 13 state def","0","0","0","0","0","0"
"UE","63","90","Used durable med equipment","0","0","0","0","0","0"
"UF","63","90","Services provided, morning","0","0","0","0","0","0"
"UG","63","90","Services provided, afternoon","0","0","0","0","0","0"
"UH","63","90","Services provided, evening","0","0","0","0","0","0"
"UJ","63","90","Services provided, night","0","0","0","0","0","0"
"UK","63","90","Svc on behalf client-collat","0","0","0","0","0","0"
"UN","63","90","Two patients served","0","0","0","0","0","0"
"UP","63","90","Three patients served","0","0","0","0","0","0"
"UQ","63","90","Four patients served","0","0","0","0","0","0"
"UR","63","90","Five patients served","0","0","0","0","0","0"
"US","63","90","Six or more patients served","0","0","0","0","0","0"
"V1","66","90","Demonstration modifier 1","0","0","0","0","0","0"
"V2","66","90","Demonstration modifier 2","0","0","0","0","0","0"
"V3","66","90","Demonstration modifier 3","0","0","0","0","0","0"
"V4","81","90","Demonstration modifier 4","0","0","0","0","0","0"
"V5","63","90","Vascular catheter","0","0","0","0","0","0"
"V6","63","90","Arteriovenous graft","0","0","0","0","0","0"
"V7","63","90","Arteriovenous fistula","0","0","0","0","0","0"
"VM","71","90","Mdpp virtual make-up session","0","0","0","0","0","0"
"VP","63","90","Aphakic patient","0","0","0","0","0","0"
"X1","70","90","Continuous/broad services","0","0","0","0","0","0"
"X2","70","90","Continuous/focused services","0","0","0","0","0","0"
"X3","70","90","Episodic/broad services","0","0","0","0","0","0"
"X4","70","90","Episodic/focused services","0","0","0","0","0","0"
"X5","70","90","Svc req by another clinician","0","0","0","0","0","0"
"XE","63","90","Separate encounter","0","1","0","0","0","0"
"XP","63","90","Separate practitioner","0","1","0","0","0","0"
"XS","63","90","Separate organ/structure","0","1","0","0","0","0"
"XU","63","90","Unusual separate service","0","1","0","0","0","0"
"ZA","63","70","Novartis/sandoz","0","0","0","0","0","0"
"ZB","63","70","Pfizer/hospira","0","0","0","0","0","0"
"ZC","68","68","Merck/samsung bioepis","20170724","0","0","0","0","0"
"ZC","69","70","Merck/samsung bioepis","0","0","0","0","0","0"
