DME Modifiers

-KX Requirements specified in medical policy have been met.

-EY No physician or other licensed health care provider order for this item or service (Items
billed to the DMERC before a signed and dated order has been received by the supplier must be submitted with an EY modifier added to each affected HCPCS code)

HCPCS Modifiers

-GJ “OPT OUT” physician providing emergency / urgent care
-GP Services were provided under an outpatient physical therapy plan of care
-GWService not related to hospice patient’s terminal care (used when a hospice patient is seen,but services are unrelated to the terminal condition)

– AQ (replaces QB ad QU) Physician services provided in health provider shortage area (HPSA)
-QW CLIA waived test
-LT Left foot
-TA Left great toe
-T1 2nd toe, left foot
-T2 3rd toe, left foot
-T3 4th toe, left foot
-T4 5th toe, left foot
-RT Right foot
-T5 Right great toe
-T6 2nd toe, right foot
-T7 3rd toe, right foot
-T8 4th toe, right foot
-T9 5th toe, right foot
-Q5 Service provided by substitute physician under reciprocal billing arrangement
-Q6 Services provided by a locum tenens physician
-AS Assistant at Surgery of a physician assistant, nurse practitioner or clinical nurse practitioner
• -GC Service performed in part by resident under direction of teaching physician (informational only)
• -GE Service performed by a resident without the presence of a teaching physician [primary care exception] (informational only)
-Q7 One Class A finding
-Q8 Two Class B findings
-Q9 One Class B and Two Class C findings