Modifier Listing for Medicare Part B
GQ Via asynchronous telecommunications system
GT Via interactive audio and video telecommunication system
GV Attending physician not employed or paid under agreement by the patient’s hospice provider
GW Services not related to the hospice patient’s terminal condition
GY Item or service statutorily non-covered or is not a Medicare benefit
GZ Item or service may not be reasonable and necessary
G1 Most recent URR reading of less than 60
G2 Most recent URR reading of 60 to 64.9
G3 Most recent URR reading of 65 to 69.9
G4 Most recent URR reading of 70 to 74.9
G5 Most recent URR reading of 75 or greater
G6 ESRD patient for whom less than 6 dialysis sessions have been provided in a month
G7 Pregnancy resulted from rape or incest, or pregnancy certified by physician as life threatening
G8 Monitored anesthesia care for deep, complex, complicated or marked invasive surgical procedure
G9 Monitored anesthesia care for patient who has history of severe cardio-pulmonary condition
J1 Competitive Acquisition Program (CAP) “ no pay for prescription number
J2 Competitive Acquisition Program (CAP) restock of emergency drug
J3 Competitive Acquisition Program (CAP) drug unavailable as written
JA Administered intravenously
JB Administered subcutaneously
JW Discarded drug not administered
KO Single drug unit dose formulation
KP First drug of multiple drug unit dose formulation
KQ Second or subsequent drug of a multiple drug unit dose formulation
KS Glucose monitor supply for diabetic beneficiary not treated with insulin
KZ New coverage not implemented by managed care
LC Left circumflex coronary artery
LD Left anterior descending coronary artery
LR Laboratory round trip
LS FDA-monitored intraocular lens implant
LT Left side of the body
M2 Competitive Acquisition Program (CAP) Medicare secondary payer
QB Physician providing services in a rural HPSA
QC Single channel cardiac monitoring
QJ Services/items provided to a prisoner or patient in a state or local custody, however, the state or
local government, as applicable, meets requirements in 42 CFR 411.4(B)
QK Medical direction of two, three or four concurrent anesthesia
QP Documentation is on file showing that the laboratory test(s) was ordered individually
QQ Service for which a statement of intent was submitted, deemed as valid, and an acknowledgment letter was received
QS Monitored anesthesia care service
QT Recording and storage on tape by an analog tape recorder
QU Physician providing services in an urban HPSA
QW CLIA waived lab tests
QX CRNA anesthesia with medical direction
QY Anesthesiologist medically directs one CRNA
QZ CRNA anesthesia without medical direction
Q0 Item/service in Medicare study
Q1 Item or service provided as routine care in a Medicare Clinical Research study
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