01316
Procedure Code Modifier
2014-03-17
Definition: This field contains the procedure code modifier to the procedure code reported in FT1-25 - Procedure Code, when applicable. Procedure code modifiers are defined by regulatory agencies such as CMS and the AMA. Multiple modifiers may be reported. The modifiers are sequenced in priority according to user entry. This is a requirement of the UB and the 1500 claim forms. Multiple modifiers are allowed and the order placed on the form affects reimbursement. Refer to Externally-defined Table 0340 - Procedure Code Modifier in Chapter 2C, Code Tables, for suggested values.
Usage Rule: This field can only be used if FT1-25 - Procedure Code contains certain procedure codes that require a modifier in order to be billed or performed. For example, HCPCS codes that require a modifier to be precise.
Procedure Code Modifier Coding Systems (From HL7 Table 0396)
Code
CPTM CPT Modifier Code Available for the AMA at the address listed for CPT above. These codes are found in Appendix A of CPT 2000 Standard Edition. (CPT 2000 Standard Edition, American Medical Association, Chicago, IL).HPC CMS (formerly HCFA )Procedure Codes (HCPCS) Health Care Financing Administration (HCFA) Common Procedure Coding System (HCPCS) including modifiers.I10P ICD-10 Procedure Codes Procedure Coding System (ICD-10-PCS.) See http://www/hcfa.gov/stats/icd10.icd10.htm for more information.I9C ICD-9CM Commission on Professional and Hospital Activities, 1968 Green Road, Ann Arbor, MI 48105 (includes all procedures and diagnostic tests).ICD10AM ICD-10 Australian modificationICD10CA ICD-10 Canada
LengthNot specified
2 values
CPTM | CPT Modifier Code(Available for the AMA at the address listed for CPT above. These codes are found in Appendix A of CPT 2000 Standard Edition. (CPT 2000 Standard Edition, American Medical Association, Chicago, IL)) | Deprecated |
HPC | CMS (formerly HCFA) Procedure Codes (HCPCS)(Health Care Financing Administration (HCFA) Common Procedure Coding System (HCPCS) including modifiers.) | Deprecated |
22 components
| 1 | R | - | Identifier | |
| 2 | O | - | Text | |
| 3 | O | Name of Coding System | ||
| 4 | O | - | Alternate Identifier | |
| 5 | O | - | Alternate Text | |
| 6 | O | Name of Alternate Coding System | ||
| 7 | C | - | Coding System Version ID | |
| 8 | O | - | Alternate Coding System Version ID | |
| 9 | O | - | Original Text | |
| 10 | O | - | Second Alternate Identifier | |
| 11 | O | - | Second Alternate Text | |
| 12 | O | Name of Second Alternate Coding System | ||
| 13 | C | - | Second Alternate Coding System Version ID | |
| 14 | C | - | Coding System OID | |
| 15 | O | - | Value Set OID | |
| 16 | C | - | Value Set Version ID | |
| 17 | C | - | Alternate Coding System OID | |
| 18 | O | - | Alternate Value Set OID | |
| 19 | C | - | Alternate Value Set Version ID | |
| 20 | C | - | Second Alternate Coding System OID | |
| 21 | O | - | Second Alternate Value Set OID | |
| 22 | C | - | Second Alternate Value Set Version ID |