Medical and Surgical
Dental Procedures
Modifiers
Index
Temporary Procedures/Professional Services
100
A4642
Indium In-111 satumomab pendetide, diagnostic, per study dose, up to 6 millicuries
100
D0382
Cone beam CT image capture with field of view of one full dental arch- maxilla, with or without cranium
100
KA
Add on option/accessory for wheelchair
100
Multiple post collar, cervical
L0180-L0200
100
G0186
Destruction of localized lesion of choroid (for example, chorodial neovascularization); photocoagulation, feeder vessel technique (one or more sessions)
200
A9155
Artificial Saliva, 30 ml
200
D0470 is the code for Periodic Oral Evaluation. True or False
False. D0120 is the correct code for Periodic Oral Evaluation.
200
H9
Court ordered
200
The correct code range for Laboratory, Dental is P0000-P9999
False. P0000-P9999 is for Laboratory, Services
200
G9001
Coordinated care fee, initial rate
300
A4619
Face Tent
300
D0475
Decalcification Procedure
300
GU
Waiver of liability statement issued as required by payer policy, routine notice. It is also a Carrier Discretion modifier
300
Water collection device, large volume nebulizer
A7012
300
G8765
All quality actions for the applicable measures in the cataract measures group have been performed for this patient
400
is A4639 the correct code for an Oropharyngeal Suction catheter,each
No the correct code is A4628
400
D0479 is the correct code for a Tissue In-Situ hybridization, including interpretation. True or False
True.
400
FB is a covered by Medicare and is also the modifier code for Left hand, thumb code. True or False
False. FB is not covered or valid by Medicare. The correct modifier for Left hand, thumb is FA
400
Vacuum erection system
L7900
400
G8754
Most recent diastolic blood pressure <90 mm hg
500
A0021 is the correct code for an ALS routine disposable supplies. True or False
False. The correct code for ALS routine disposable supplies is A0398. A0021 is an Ambulance Service, outside state per mile, tansport (Medicaid only)
500
D9410
House/extended care facility call
500
AM
Physician, team member service. Not assigned for Medicare. Also is a Special Coverage Instructions
500
gaseous oxygen
K0741, K0742
500
G8779
Diabetes screening test not performed, reason not given