- First position - Pricing modifiers. i.e., RR, KH, KI, KJ, NU
- Second position - Modifiers to indicate requirements specified in the medical policy have been met. i.e., KX
- Other positions - Any additional informational modifiers required
Modifiers can be alphabetic, numeric, or a combination of both, but will always be two digits. Some modifiers cause automated pricing changes, while others are used to convey information only. They are not required on all HCPCS codes; however, if required and not submitted, the claim will deny as unprocessable. Be sure to distinguish between zeros and the letter "O".
RT and LT modifiers - When billing for bilateral items on the same date of service:
- Bill bilateral items on two separate claim lines using the RT and LT modifiers and 1 unit of service (UOS) on each claim line
GA or GZ or GY, and KX must never be used on the same claim line together as the claim will deny as unprocessable and the claim will need to be corrected and rebilled.
Some miscellaneous codes may require a specific modifier according to the policy and laterality modifiers shown on the tool, as well as additional details provided in the claim line narrative.
Disclaimer: This tool does not include all DMEPOS modifiers or HCPCS codes and does not guarantee coverage for the item(s) billed. Refer to the Modifiers page and appropriate Local Coverage Determination and/or Policy Article for additional modifier usage.
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