Bundled, Inactive, and Non-Payable Codes for 2015: Medicare Physician Fee Schedule Database

2015The Centers for Medicare & Medicaid Services (CMS) designates the status of HCPCS and CPT codes in the Medicare Physician Fee Schedule Database (MPFSDB). The status of codes may be updated periodically throughout the year and when the calendar year changes. Codes designated as Status A are active codes, are separately payable under the Medicare Physician Fee Schedule (assuming any existing coverage criteria are met), and have associated Relative Value Units (RVUs) and payment amounts. The list of Status A codes is extensive, and these codes are not listed in this publication.

January 30, 2015© 2015 Copyright, CGS Administrators, LLC.

Status B 2

Status C 3

Status E 9

Status I 15

Status J 25

Status M 27

Status N 33

Status P 38

Status Q 40

Status R 41

Status T 43

Status X 44

January 30, 2015© 2015 Copyright, CGS Administrators, LLC. PAGE 2Modifier 26 is a CPT modifier, and

modifier TC is a HCPCS modifier.

STATUS BStatus B codes are bundled. Payment for these services is always included in payment for other services not specified. There are no RVUs or payment amounts for these codes, and separate payment is not made.

CPT Codes Modifier15850209302093622841360003641638204908859088790889923529235392354923559235892371925319253292533925349260592606926189292192925929299293492938929449374093770940059415094150 2694150 TC

CPT Codes Modifier9604096902970109760298960989619896299000990019900299024990509905199053990569905899060990709907199078990809909099091991009911699135991409928899339993409935899359993639936499366

CPT Codes Modifier9936799368993749937799379993809944699447994489944999485994869948799489

HCPCS Codes ModifierA4262A4263A4270A4300A4550G0269Q3031R0076

January 30, 2015© 2015 Copyright, CGS Administrators, LLC. PAGE 3Modifier 26 is a CPT modifier, and

modifier TC is a HCPCS modifier.

STATUS CStatus C are priced by each contractor. CGS establishes RVUs and payment amounts for these services, generally on an individual basis, based on review of documentation (such as operative reports).

CPT Codes Modifier15847159991799919499209992108821089212992149921742217432189922899229992392924940249992599926989272992759927899288992979929999309993129931599318993285532856329993393333944

CPT Codes Modifier33999348393484134842348433484434845348463484734848362993719537501377993812938589389993949939599407994089941599418994229942699429994328943496434994364743648436594377543881

CPT Codes Modifier43882439994413744238447154489944979454994599946999471434714447145473794739947579479994855148999493294965949906499995032350325505495094951999538995444054699555595589955970

CPT Codes Modifier55980585785857958679589745899959897598985989960659606996304363044649996575766999672996739967599679996839968899693996979969949699797017070170 TC7055570555 TC7055770557 TC7055870558 TC

January 30, 2015© 2015 Copyright, CGS Administrators, LLC. PAGE 4

Bundled, Inactive, and Non-Payable Codes for 2015: Medicare Physician Fee Schedule Database

Modifier 26 is a CPT modifier, and modifier TC is a HCPCS modifier.

CPT Codes Modifier7055970559 TC7353073530 TC7419074190 TC7423574235 TC7430074300 TC7430174301 TC7430574305 TC7432874328 TC7432974329 TC7433074330 TC7434074340 TC7435574355 TC7436074360 TC7436374363 TC7442074420 TC7442574425 TC7444574445 TC7445074450 TC7447074470 TC74742

CPT Codes Modifier74742 TC7477574775 TC7580175801 TC7580375803 TC7580575805 TC7580775807 TC7581075810 TC7589475894 TC7589675896 TC7589875898 TC7594575945 TC7594675946 TC7595275952 TC7595375953 TC7595475954 TC7595675956 TC7595775957 TC7595875958 TC7595975959 TC7597075970 TC

CPT Codes Modifier7598075980 TC7598275982 TC7600176001 TC7612576125 TC7649676496 2676496 TC7649776497 2676497 TC7649876498 2676498 TC7649976499 2676499 TC7693076930 TC7693276932 TC7694076940 TC7694176941 TC7694576945 TC7697576975 TC7699876998 TC7699976999 2676999 TC7701377013 TC

CPT Codes Modifier7702277022 TC7729977299 2677299 TC773717739977399 2677399 TC7749977499 2677499 TC775207752277523775257779977799 2677799 TC7809978099 2678099 TC7819978199 2678199 TC7828278282 TC7829978299 2678299 TC7839978399 2678399 TC7841478414 TC7845978459 TC7849178491 TC

STATUS C

January 30, 2015© 2015 Copyright, CGS Administrators, LLC. PAGE 5

Bundled, Inactive, and Non-Payable Codes for 2015: Medicare Physician Fee Schedule Database

Modifier 26 is a CPT modifier, and modifier TC is a HCPCS modifier.

CPT Codes Modifier7849278492 TC7849978499 2678499 TC7859978599 2678599 TC7860878608 TC7869978699 2678699 TC7879978799 2678799 TC7881178811 TC7881278812 TC7881378813 TC7881478814 TC7881578815 TC7881678816 TC7899978999 2678999 TC7930079300 TC7944579445 TC7999979999 2679999 TC86485

CPT Codes Modifier8819988199 2688199 TC882998839988399 2688399 TC89240908679086890869908999095290953909999129991299 2691299 TC9249992499 2692499 TC927009297892978 TC9297992979 TC9299292993932999331593315 TC9331793317 TC9331893318 TC9353093530 TC9353193531 TC

CPT Codes Modifier9353293532 TC9353393533 TC9356193561 TC9356293562 TC9357193571 TC9357293572 TC9360093600 TC9360293602 TC9360393603 TC9360993609 TC9361093610 TC9361293612 TC9361593615 TC9361693616 TC9361893618 TC9361993619 TC9362093620 TC9362193621 TC9362293622 TC93623

CPT Codes Modifier93623 TC9362493624 TC9363193631 TC9364093640 TC9364193641 TC9366293662 TC9374593745 2693745 TC9379993799 2693799 TC93998946429477294772 2694772 TC947749477594776947779479994799 2694799 TC951999582495824 TC9594395943 2695943 TC9595195951 TC9596595965 TC

STATUS C

January 30, 2015© 2015 Copyright, CGS Administrators, LLC. PAGE 6

Bundled, Inactive, and Non-Payable Codes for 2015: Medicare Physician Fee Schedule Database

Modifier 26 is a CPT modifier, and modifier TC is a HCPCS modifier.

CPT Codes Modifier9596695966 TC9596795967 TC959999602096020 TC96379965499699997039971399760797608977999908299143991449914599148991499915099199994990019T0042T0051T0052T0053T0054T0055T0058T0071T0072T0075T0075T 260075T TC0076T0076T 26

CPT Codes Modifier0076T TC0095T0098T0099T0100T0101T0102T0103T0106T0107T0108T0109T0110T0111T0123T0126T0159T0159T 260159T TC0163T0164T0165T0169T0171T0172T0174T0175T0178T0179T0180T0182T0182T 260182T TC0184T0190T0191T0195T0196T0198T

CPT Codes Modifier0200T0201T0202T0205T0206T0207T0208T0209T0210T0211T0212T0213T0214T0215T0216T0217T0218T0219T0220T0221T0222T0223T0224T0225T0228T0229T0230T0231T0232T0233T0234T0235T0236T0237T0238T0240T0240T 260240T TC0241T

CPT Codes Modifier0241T 260241T TC0243T0243T 260243T TC0244T0244T 260244T TC0249T0253T0254T0255T0255T 260255T TC0262T0263T0264T0265T0266T0267T0268T0269T0270T0271T0272T0273T0274T0278T0281T0282T0283T0284T0285T0286T0287T0288T0289T0290T0291T

STATUS C

January 30, 2015© 2015 Copyright, CGS Administrators, LLC. PAGE 7

Bundled, Inactive, and Non-Payable Codes for 2015: Medicare Physician Fee Schedule Database

Modifier 26 is a CPT modifier, and modifier TC is a HCPCS modifier.

CPT Codes Modifier0292T0293T0294T0295T0296T0297T0298T0299T0300T0301T0302T0303T0304T0305T0306T0307T0308T0309T0310T0311T0312T0313T0314T0315T0316T0317T0329T0330T0331T0332T0333T0335T0336T0337T0338T0339T0340T0341T0342T

CPT Codes Modifier0345T0346T0347T0348T0349T0350T0351T0352T0353T0354T0355T0356T0357T0358T0359T0360T0361T0362T0363T0364T0365T0366T0367T0368T0369T0370T0371T0372T0373T0374T0375T0376T0377T0378T0379T0380T0381T0382T0383T

HCPCS Codes ModifierA9502A9503A9504A9505A9507A9508A9509A9510A9512A9516A9517A9521A9524A9526A9527A9528A9529A9530A9531A9532A9536A9537A9538A9539A9540A9541A9542A9543A9544A9545A9546A9547A9548A9550A9551A9552A9553A9554A9555

STATUS C

CPT Codes Modifier0384T0385T0386T0387T0388T0389T0390T0391T

January 30, 2015© 2015 Copyright, CGS Administrators, LLC. PAGE 8

Bundled, Inactive, and Non-Payable Codes for 2015: Medicare Physician Fee Schedule Database

Modifier 26 is a CPT modifier, and modifier TC is a HCPCS modifier.

HCPCS Codes ModifierA9556A9557A9558A9559A9560A9561A9562A9563A9564A9566A9567A9568A9569A9570A9571A9572A9580A9586A9599A9600A9699G0186G0339G0340G0398G0398 26G0398 TCG0399G0399 26G0399 TCG0400G0400 26G0400 TCG0460G6017G6021G6027G6028Q3001

STATUS C

HCPCS Codes ModifierR0070R0075

January 30, 2015© 2015 Copyright, CGS Administrators, LLC. PAGE 9Modifier 26 is a CPT modifier, and

modifier TC is a HCPCS modifier.

STATUS EStatus E are excluded from the MPFS by regulation. There are no RVUs or payment amounts for these codes, and separate payment is not made.

CPT Codes Modifier90296903719037590376903859039390396904769047790581905859058690632906339063490636906459064690647906489064990650906759067690680906819069090691906929069390696906989070090702

CPT Codes Modifier9070390704907059070690707907089071090712907139071490715907169071790719907209072190725907279073390734907359073690749

HCPCS Codes ModifierA9150A9700G0157G0158G0159G0160G0161G0162G0163G0164G0257G0259G0260G0293G0294G0448G0458J0120J0129J0130J0131J0132J0133J0135J0150J0151J0153J0171J0178J0180J0190J0200J0205J0207

HCPCS Codes ModifierJ0210J0215J0220J0221J0256J0257J0270J0275J0278J0280J0282J0285J0287J0288J0289J0290J0295J0300J0330J0348J0350J0360J0364J0365J0380J0390J0395J0400J0401J0456J0461J0470J0475J0476

January 30, 2015© 2015 Copyright, CGS Administrators, LLC. PAGE 10

Bundled, Inactive, and Non-Payable Codes for 2015: Medicare Physician Fee Schedule Database

Modifier 26 is a CPT modifier, and modifier TC is a HCPCS modifier.

HCPCS Codes ModifierJ0480J0485J0490J0500J0515J0520J0558J0561J0571J0572J0573J0574J0575J0583J0585J0586J0587J0588J0592J0594J0595J0597J0598J0600J0610J0620J0630J0636J0637J0638J0640J0641J0670J0690J0692J0694J0696J0697J0698

STATUS E

HCPCS Codes ModifierJ0702J0706J0710J0712J0713J0715J0716J0717J0720J0725J0735J0740J0743J0744J0745J0760J0770J0775J0780J0795J0800J0833J0834J0840J0850J0878J0881J0882J0885J0886J0887J0888J0890J0894J0895J0897J0900J0945J1000

HCPCS Codes ModifierJ1020J1030J1040J1050J1060J1070J1071J1080J1094J1100J1110J1120J1160J1162J1165J1170J1180J1190J1200J1205J1212J1230J1240J1245J1250J1260J1265J1267J1270J1290J1300J1320J1322J1324J1325J1327J1330J1335J1364

HCPCS Codes ModifierJ1380J1410J1430J1435J1436J1438J1439J1442J1446J1450J1451J1452J1453J1455J1457J1458J1459J1460J1556J1557J1559J1560J1561J1562J1566J1568J1569J1570J1571J1572J1573J1580J1590J1595J1599J1600J1602J1610J1620

January 30, 2015© 2015 Copyright, CGS Administrators, LLC. PAGE 11

Bundled, Inactive, and Non-Payable Codes for 2015: Medicare Physician Fee Schedule Database

Modifier 26 is a CPT modifier, and modifier TC is a HCPCS modifier.

HCPCS Codes ModifierJ1626J1630J1631J1640J1642J1644J1645J1650J1652J1655J1670J1675J1700J1710J1720J1725J1730J1740J1741J1742J1743J1744J1745J1750J1756J1786J1790J1800J1810J1815J1817J1830J1835J1840J1850J1885J1890J1930J1931

HCPCS Codes ModifierJ1940J1945J1950J1953J1955J1956J1960J1980J1990J2001J2010J2020J2060J2150J2170J2175J2180J2185J2210J2212J2248J2250J2260J2265J2270J2274J2278J2280J2300J2310J2315J2320J2323J2325J2353J2354J2355J2357J2358

HCPCS Codes ModifierJ2360J2370J2400J2405J2410J2425J2426J2430J2440J2460J2469J2501J2503J2504J2505J2507J2510J2513J2515J2540J2543J2545J2550J2560J2562J2590J2597J2650J2670J2675J2680J2690J2700J2704J2710J2720J2724J2725J2730

HCPCS Codes ModifierJ2760J2765J2770J2778J2780J2783J2785J2788J2790J2791J2792J2793J2794J2795J2796J2800J2805J2810J2820J2850J2910J2916J2920J2930J2940J2941J2950J2993J2995J2997J3000J3010J3030J3060J3070J3095J3101J3105J3110

STATUS E

January 30, 2015© 2015 Copyright, CGS Administrators, LLC. PAGE 12

Bundled, Inactive, and Non-Payable Codes for 2015: Medicare Physician Fee Schedule Database

Modifier 26 is a CPT modifier, and modifier TC is a HCPCS modifier.

HCPCS Codes ModifierJ3120J3121J3130J3140J3145J3150J3230J3240J3243J3246J3250J3260J3262J3265J3280J3285J3300J3301J3302J3303J3305J3310J3315J3320J3350J3355J3357J3360J3364J3365J3370J3385J3396J3400J3410J3411J3415J3420J3430

HCPCS Codes ModifierJ3465J3470J3471J3472J3473J3475J3480J3485J3486J3489J3490J3530J3590J7030J7040J7042J7050J7060J7070J7100J7110J7120J7131J7178J7180J7181J7182J7183J7185J7186J7187J7189J7196J7200J7201J7308J7309J7310J7311

HCPCS Codes ModifierJ7312J7315J7316J7321J7323J7324J7325J7326J7327J7330J7335J7336J7502J7507J7508J7511J7513J7515J7516J7517J7518J7520J7525J7527J7604J7605J7606J7607J7608J7609J7610J7611J7612J7613J7614J7615J7620J7622J7624

HCPCS Codes ModifierJ7626J7627J7628J7629J7631J7632J7633J7634J7635J7636J7637J7638J7639J7640J7641J7642J7643J7644J7645J7647J7648J7649J7650J7657J7658J7659J7660J7665J7667J7668J7669J7670J7674J7676J7680J7681J7682J7683J7684

STATUS E

January 30, 2015© 2015 Copyright, CGS Administrators, LLC. PAGE 13

Bundled, Inactive, and Non-Payable Codes for 2015: Medicare Physician Fee Schedule Database

Modifier 26 is a CPT modifier, and modifier TC is a HCPCS modifier.

HCPCS Codes ModifierJ7685J7686J7699J7799J8498J8501J8510J8520J8521J8530J8540J8560J8562J8597J8600J8610J8650J8700J8705J8999J9000J9010J9015J9017J9019J9020J9025J9027J9031J9033J9035J9040J9041J9042J9043J9045J9047J9050J9055

HCPCS Codes ModifierJ9060J9065J9070J9098J9100J9120J9130J9150J9151J9155J9160J9165J9171J9175J9178J9179J9181J9185J9190J9200J9201J9202J9206J9207J9208J9209J9211J9212J9213J9214J9215J9216J9217J9218J9219J9225J9226J9228J9230

HCPCS Codes ModifierJ9245J9250J9260J9261J9262J9263J9264J9265J9266J9267J9268J9270J9280J9293J9300J9301J9302J9303J9305J9306J9307J9310J9315J9320J9328J9330J9340J9351J9354J9355J9357J9360J9370J9371J9390J9395J9400J9600J9999

HCPCS Codes ModifierP9010P9011P9012P9016P9017P9019P9020P9021P9022Q0081Q0083Q0084Q0085Q0138Q0139Q0161Q0162Q0478Q0479Q0480Q0481Q0482Q0483Q0484Q0485Q0486Q0487Q0488Q0489Q0490Q0491Q0492Q0493Q0494Q0495Q0496Q0497Q0498Q0499

STATUS E

January 30, 2015© 2015 Copyright, CGS Administrators, LLC. PAGE 14

Bundled, Inactive, and Non-Payable Codes for 2015: Medicare Physician Fee Schedule Database

Modifier 26 is a CPT modifier, and modifier TC is a HCPCS modifier.

HCPCS Codes ModifierQ0500Q0501Q0502Q0503Q0504Q0506Q0507Q0508Q0509Q0510Q0511Q0512Q0513Q0514Q0515Q2004Q2009Q2017Q2026Q2028Q2043Q2049Q2050Q2052Q3027Q4074Q4081Q4082Q4100Q4101Q4102Q4103Q4104Q4105Q4106Q4107Q4108Q4110Q4111

HCPCS Codes ModifierQ4112Q4113Q4114Q4115Q4116Q4117Q4118Q4119Q4120Q4121Q4122Q4123Q4124Q4125Q4126Q4127Q4128Q4129Q4130Q4137Q4138Q4139Q4140Q4141Q4142Q4143Q4145Q4146Q4147Q4148Q4149Q4150Q4151Q4152Q4153Q4154Q4155Q4156Q4157

HCPCS Codes ModifierQ4158Q4159Q4160Q5001Q5002Q5003Q5004Q5005Q5006Q5007Q5008Q5009Q5010Q9951Q9953Q9954Q9955Q9956Q9957Q9958Q9959Q9960Q9961Q9962Q9963Q9964Q9965Q9966Q9967Q9968Q9969Q9970Q9974

STATUS E

January 30, 2015© 2015 Copyright, CGS Administrators, LLC. PAGE 15Modifier 26 is a CPT modifier, and

modifier TC is a HCPCS modifier.

STATUS I Status I are not valid for Medicare purposes. Medicare uses another CPT or HCPCS code for reporting these services.

CPT Codes Modifier27215272162721727218382073820838209382103821138212382133821438215443814438444401444024440344404444054440644407444084470544799453464534745349453504538845389453904539345398

CPT Codes Modifier453994660146607761407706177061 2677061 TC7706277062 2677062 TC773857738677387774027740777412800558150081503815068150881509815108151181512815999028190283902879028890291903849038690389

CPT Codes Modifier90399906589072390738907489086392630926339512095125951309513195132951339513495941970059700697014992419924299243992449924599251992529925399254992559937599378994979949899500

CPT Codes Modifier99501995029950399504995059950699507995099951099511995129960099601996020001F0005F0012F0014F0015F0501F0502F0503F0505F0507F0514F0516F0519F0525F0535F0545F0550F0551F0555F0556F

January 30, 2015© 2015 Copyright, CGS Administrators, LLC. PAGE 16

Bundled, Inactive, and Non-Payable Codes for 2015: Medicare Physician Fee Schedule Database

Modifier 26 is a CPT modifier, and modifier TC is a HCPCS modifier.

CPT Codes Modifier0575F0580F0581F0582F0583F0584F1000F1002F1003F1004F1005F1007F1008F1015F1018F1019F1022F1026F1030F1031F1032F1033F1034F1035F1040F1050F1052F1055F1060F1061F1065F1066F1070F1071F1091F1110F1116F1118F1119F

CPT Codes Modifier1121F1127F1128F1130F1134F1135F1136F1137F1150F1151F1152F1153F1157F1158F1159F1160F1180F1182F1183F1200F1205F1220F1450F1451F1500F1501F1502F1503F1504F1505F2001F2002F2004F2010F2014F2015F2016F2018F2020F

CPT Codes Modifier2021F2028F2029F2030F2031F2035F2040F2044F2050F2060F3006F3008F3011F3015F3018F3019F3020F3025F3027F3028F3035F3037F3038F3040F3042F3048F3049F3050F3055F3056F3073F3074F3075F3077F3078F3079F3080F3082F3083F

CPT Codes Modifier3084F3085F3088F3089F3090F3091F3092F3093F3110F3111F3112F3115F3117F3118F3119F3130F3132F3140F3141F3142F3150F3200F3216F3218F3220F3230F3265F3266F3268F3272F3273F3274F3278F3279F3280F3281F3290F3291F3292F

STATUS I

January 30, 2015© 2015 Copyright, CGS Administrators, LLC. PAGE 17

Bundled, Inactive, and Non-Payable Codes for 2015: Medicare Physician Fee Schedule Database

Modifier 26 is a CPT modifier, and modifier TC is a HCPCS modifier.

CPT Codes Modifier3293F3294F3317F3318F3323F3324F3325F3328F3330F3331F3351F3352F3353F3354F3450F3451F3452F3490F3491F3492F3493F3497F3498F3500F3502F3503F3511F3512F3513F3514F3515F3520F3550F3551F3552F3555F3572F3573F3650F

CPT Codes Modifier3750F3751F3752F3753F3754F3755F3756F3757F3758F3759F3760F3761F3762F3763F4000F4001F4003F4011F4012F4013F4014F4015F4016F4017F4018F4019F4030F4033F4035F4037F4041F4043F4045F4047F4048F4050F4051F4052F4053F

CPT Codes Modifier4054F4055F4056F4058F4060F4062F4063F4064F4065F4066F4067F4069F4070F4073F4077F4079F4084F4095F4133F4134F4135F4136F4145F4149F4150F4153F4155F4157F4158F4159F4163F4165F4167F4168F4169F4171F4172F4174F4176F

STATUS I

CPT Codes Modifier4178F4180F4181F4182F4185F4186F4188F4189F4190F4191F4200F4201F4210F4220F4221F4230F4240F4242F4245F4248F4256F4260F4261F4265F4266F4267F4268F4269F4270F4271F4274F4276F4279F4280F4290F4293F4300F4301F4305F

January 30, 2015© 2015 Copyright, CGS Administrators, LLC. PAGE 18

Bundled, Inactive, and Non-Payable Codes for 2015: Medicare Physician Fee Schedule Database

Modifier 26 is a CPT modifier, and modifier TC is a HCPCS modifier.

HCPCS Codes ModifierA0021A0080A0090A0100A0110A0120A0130A0140A0160A0170A0180A0190A0200A0210A0225A0380A0390A0998A4232A4264A4266A4267A4268A4269A4466A4555A4566A4570A4580A4590A9152A9153A9180A9272A9274A9279D0210D0220D0230

HCPCS Codes ModifierD0290D0310D0320D0321D0322D0330D0340D0350D0351D1352D3354D4210D4211D4212D5913D5914D5915D5916D5919D5922D5923D5924D5925D5926D5927D5928D5929D5931D5932D5933D5934D5935D5936D5937D5952D5953D5954D5955D5958

STATUS I

CPT Codes Modifier4306F4320F4324F4326F4330F4350F4450F4470F4480F4481F4540F4541F4550F4551F4552F4553F4554F4555F4556F4557F4558F4559F4560F4561F4562F4563F5005F5020F5060F5062F5100F5200F5250F6005F6010F6015F6020F6040F6070F

CPT Codes Modifier6080F6090F6100F7020F9001F9002F9005F

January 30, 2015© 2015 Copyright, CGS Administrators, LLC. PAGE 19

Bundled, Inactive, and Non-Payable Codes for 2015: Medicare Physician Fee Schedule Database

Modifier 26 is a CPT modifier, and modifier TC is a HCPCS modifier.

HCPCS Codes ModifierD5959D5960D5982D5988D5992D5993D5994D5999D6010D6011D6040D6050D6055D6080D6090D6095D6100D6101D6102D6103D6104D6199D7251D7285D7286D7287D7295D7310D7320D7340D7350D7410D7411D7412D7413D7414D7415D7440D7441

HCPCS Codes ModifierD7450D7451D7460D7461D7465D7471D7472D7473D7485D7490D7510D7520D7530D7540D7550D7560D7610D7620D7630D7640D7650D7660D7670D7671D7680D7710D7720D7730D7740D7750D7760D7770D7771D7780D7810D7820D7830D7840D7850

HCPCS Codes ModifierD7852D7854D7856D7858D7860D7865D7870D7872D7873D7874D7875D7876D7877D7880D7899D7910D7911D7912D7920D7921D7941D7943D7944D7945D7946D7947D7948D7949D7950D7955D7960D7970D7971D7972D7980D7981D7982D7983D7990

HCPCS Codes ModifierD7991D7995D7996D7999D9210D9211D9212D9215D9219D9220D9221D9241D9242D9310D9410D9420D9430D9440D9450D9610D9985D9986D9987D9999G8559G8560G8561G8562G8563G8564G8565G8566G8567G8568G9050G9051G9052G9053G9054

STATUS I

January 30, 2015© 2015 Copyright, CGS Administrators, LLC. PAGE 20

Bundled, Inactive, and Non-Payable Codes for 2015: Medicare Physician Fee Schedule Database

Modifier 26 is a CPT modifier, and modifier TC is a HCPCS modifier.

HCPCS Codes ModifierG9055G9056G9057G9058G9059G9060G9061G9062H0001H0002H0003H0004H0005H0006H0007H0008H0009H0010H0011H0012H0013H0014H0015H0016H0017H0018H0019H0020H0021H0022H0023H0024H0025H0026H0027H0028H0029H0030H0031

HCPCS Codes ModifierH0032H0033H0034H0035H0036H0037H0038H0039H0040H0041H0042H0043H0044H0045H0046H0047H0048H0049H0050H1000H1001H1002H1003H1004H1005H1010H1011H2000H2001H2010H2011H2012H2013H2014H2015H2016H2017H2018H2019

HCPCS Codes ModifierH2020H2021H2022H2023H2024H2025H2026H2027H2028H2029H2030H2031H2032H2033H2034H2035H2036H2037J1826J2271J2275J7306J7307J8565P7001Q3028S0012S0014S0017S0020S0021S0023S0028S0030S0032S0034S0039S0040S0073

HCPCS Codes ModifierS0074S0077S0078S0080S0081S0088S0090S0091S0092S0093S0104S0106S0108S0109S0117S0119S0122S0126S0128S0132S0136S0137S0138S0139S0140S0142S0144S0145S0148S0155S0156S0157S0160S0164S0166S0169S0170S0171S0172

STATUS I

January 30, 2015© 2015 Copyright, CGS Administrators, LLC. PAGE 21

Bundled, Inactive, and Non-Payable Codes for 2015: Medicare Physician Fee Schedule Database

Modifier 26 is a CPT modifier, and modifier TC is a HCPCS modifier.

HCPCS Codes ModifierS0174S0175S0176S0177S0178S0179S0182S0183S0187S0189S0190S0191S0194S0195S0197S0199S0201S0207S0208S0209S0215S0220S0221S0250S0255S0257S0260S0265S0270S0271S0272S0273S0274S0280S0281S0302S0310S0315S0316

HCPCS Codes ModifierS0317S0320S0340S0341S0342S0353S0354S0390S0395S0400S0500S0504S0506S0508S0510S0512S0514S0515S0516S0518S0580S0581S0590S0592S0595S0596S0601S0610S0612S0613S0618S0620S0621S0622S0630S0800S0810S0812S0832

HCPCS Codes ModifierS1001S1002S1015S1016S1030S1031S1034S1035S1036S1037S1040S1090S2053S2054S2055S2060S2061S2065S2066S2067S2068S2070S2079S2080S2083S2095S2102S2103S2107S2112S2115S2117S2118S2120S2140S2142S2150S2152S2202

HCPCS Codes ModifierS2205S2206S2207S2208S2209S2225S2230S2235S2260S2265S2266S2267S2300S2325S2340S2341S2342S2348S2350S2351S2360S2361S2400S2401S2402S2403S2404S2405S2409S2411S2900S3000S3005S3600S3601S3620S3630S3645S3650

STATUS I

January 30, 2015© 2015 Copyright, CGS Administrators, LLC. PAGE 22

Bundled, Inactive, and Non-Payable Codes for 2015: Medicare Physician Fee Schedule Database

Modifier 26 is a CPT modifier, and modifier TC is a HCPCS modifier.

HCPCS Codes ModifierS3652S3655S3708S3721S3722S3800S3840S3841S3842S3844S3845S3846S3849S3850S3852S3853S3854S3855S3861S3865S3866S3870S3890S3900S3902S3904S4005S4011S4013S4014S4015S4016S4017S4018S4020S4021S4022S4023S4025

HCPCS Codes ModifierS4026S4027S4028S4030S4031S4035S4037S4040S4042S4981S4989S4990S4991S4993S4995S5000S5001S5010S5011S5012S5013S5014S5035S5036S5100S5101S5102S5105S5108S5109S5110S5111S5115S5116S5120S5121S5125S5126S5130

HCPCS Codes ModifierS5131S5135S5136S5140S5141S5145S5146S5150S5151S5160S5161S5162S5165S5170S5175S5180S5181S5185S5190S5199S5497S5498S5501S5502S5517S5518S5520S5521S5522S5523S5550S5551S5552S5553S5560S5561S5565S5566S5570

HCPCS Codes ModifierS5571S8030S8035S8037S8040S8042S8055S8080S8085S8092S8096S8097S8100S8101S8110S8120S8121S8130S8131S8185S8186S8189S8210S8262S8265S8270S8301S8415S8420S8421S8422S8423S8424S8425S8426S8427S8428S8429S8430

STATUS I

January 30, 2015© 2015 Copyright, CGS Administrators, LLC. PAGE 23

Bundled, Inactive, and Non-Payable Codes for 2015: Medicare Physician Fee Schedule Database

Modifier 26 is a CPT modifier, and modifier TC is a HCPCS modifier.

HCPCS Codes ModifierS8431S8450S8451S8452S8460S8490S8930S8940S8948S8950S8990S8999S9001S9007S9015S9024S9025S9034S9055S9056S9061S9083S9088S9090S9097S9098S9110S9117S9122S9123S9124S9125S9126S9127S9128S9129S9131S9140S9141

HCPCS Codes ModifierS9145S9150S9152S9208S9209S9211S9212S9213S9214S9325S9326S9327S9328S9329S9330S9331S9335S9336S9338S9339S9340S9341S9342S9343S9345S9346S9347S9348S9349S9351S9353S9355S9357S9359S9361S9363S9364S9365S9366

HCPCS Codes ModifierS9367S9368S9370S9372S9373S9374S9375S9376S9377S9379S9381S9401S9430S9433S9434S9435S9436S9437S9438S9439S9441S9442S9443S9444S9445S9446S9447S9449S9451S9452S9453S9454S9455S9460S9465S9470S9472S9473S9474

HCPCS Codes ModifierS9475S9476S9480S9482S9484S9485S9490S9494S9497S9500S9501S9502S9503S9504S9529S9537S9538S9542S9558S9559S9560S9562S9590S9810S9900S9901S9960S9961S9970S9975S9976S9977S9981S9982S9986S9988S9989S9990S9991

STATUS I

January 30, 2015© 2015 Copyright, CGS Administrators, LLC. PAGE 24

Bundled, Inactive, and Non-Payable Codes for 2015: Medicare Physician Fee Schedule Database

Modifier 26 is a CPT modifier, and modifier TC is a HCPCS modifier.

HCPCS Codes ModifierS9992S9994S9996S9999T1000T1001T1002T1003T1004T1005T1006T1007T1009T1010T1012T1013T1014T1015T1016T1017T1018T1019T1020T1021T1022T1023T1024T1025T1026T1027T1028T1029T1030T1031T1502T1503T1505T1999T2001

HCPCS Codes ModifierT2002T2003T2004T2005T2007T2010T2011T2012T2013T2014T2015T2016T2017T2018T2019T2020T2021T2022T2023T2024T2025T2026T2027T2028T2029T2030T2031T2032T2033T2034T2035T2036T2037T2038T2039T2040T2041T2042T2043

HCPCS Codes ModifierT2044T2045T2046T2048T2049T2101T4541T4542T5001T5999

STATUS I

January 30, 2015© 2015 Copyright, CGS Administrators, LLC. PAGE 25Modifier 26 is a CPT modifier, and

modifier TC is a HCPCS modifier.

STATUS JStatus J codes are anesthesia services. Reimbursement for anesthesia services is based on the anesthesia fee schedule (not the Medicare Physician Fee Schedule), and there are no RVUs or payments contained in the MPFSDB for these services.

CPT Codes Modifier00100001020010300104001200012400126001400014200144001450014700148001600016200164001700017200174001760019000192002100021100212002140021500216002180022000222003000032000322

CPT Codes Modifier00326003500035200400004020040400406004100045000454004700047200474005000052000522005240052800529005300053200534005370053900540005410054200546005480055000560005610056200563

CPT Codes Modifier00566005670058000600006040062000625006260063000632006350064000670007000070200730007400075000752007540075600770007900079200794007960079700800008020081000820008300083200834

CPT Codes Modifier00836008400084200844008460084800851008600086200864008650086600868008700087200873008800088200902009040090600908009100091200914009160091800920009210092200924009260092800930

January 30, 2015© 2015 Copyright, CGS Administrators, LLC. PAGE 26

Bundled, Inactive, and Non-Payable Codes for 2015: Medicare Physician Fee Schedule Database

Modifier 26 is a CPT modifier, and modifier TC is a HCPCS modifier.

CPT Codes Modifier009320093400936009380094000942009440094800950009520111201120011300114001150011600117001173011800119001200012020121001212012140121501220012300123201234012500126001270012720127401320013400136001380

CPT Codes Modifier013820139001392014000140201404014200143001432014400144201444014620146401470014720147401480014820148401486014900150001502015200152201610016200162201630016340163601638016500165201654016560167001680

CPT Codes Modifier016820171001712017140171601730017320174001742017440175601758017600177001772017800178201810018200182901830018320184001842018440185001852018600191601920019220192401925019260193001931019320193301935

STATUS J

CPT Codes Modifier01936019510195201953019580196001961019620196301965019660196701968019690199001991019920199601999

January 30, 2015© 2015 Copyright, CGS Administrators, LLC. PAGE 27Modifier 26 is a CPT modifier, and

modifier TC is a HCPCS modifier.

CPT Codes Modifier0500F0509F0513F0517F0518F0520F0521F0526F0528F0529F0540F0557F1006F1010F1011F1012F1036F1038F1039F1090F1100F1101F1111F1123F1124F1125F1126F1170F1175F1181F1400F1460F1461F1490F

CPT Codes Modifier1491F1493F1494F2000F2019F2022F2024F2026F2027F3014F3016F3017F3021F3022F3023F3044F3045F3046F3060F3061F3062F3066F3072F3095F3096F3100F3120F3126F3155F3160F3170F3210F3215F3250F

CPT Codes Modifier3260F3267F3269F3270F3271F3284F3285F3288F3300F3301F3315F3316F3319F3320F3321F3322F3340F3341F3342F3343F3344F3345F3350F3370F3372F3374F3376F3378F3380F3382F3384F3386F3388F3390F

CPT Codes Modifier3394F3395F3455F3470F3471F3472F3475F3476F3494F3495F3496F3510F3517F3570F3700F3720F3725F3775F3776F4004F4005F4008F4010F4025F4040F4042F4044F4046F4049F4075F4086F4090F4100F4110F

STATUS MStatus M are measurement codes and are used for reporting purposes only. There are no RVUs or payment amounts for these codes, which include Quality Data Codes (QDCs) associated with the Physician Quality Reporting System.

January 30, 2015© 2015 Copyright, CGS Administrators, LLC. PAGE 28

Bundled, Inactive, and Non-Payable Codes for 2015: Medicare Physician Fee Schedule Database

Modifier 26 is a CPT modifier, and modifier TC is a HCPCS modifier.

CPT Codes Modifier4115F4120F4124F4130F4131F4132F4140F4142F4144F4148F4151F4164F4175F4177F4179F4187F4192F4193F4194F4195F4196F4250F4255F4322F4325F4328F4340F4400F4500F4510F4525F4526F5010F5015F5050F6030F6045F6101F6102F

CPT Codes Modifier6110F6150F7010F7025F9003F9004F9006F9007F

HCPCS Codes ModifierG0913G0914G0915G0916G0917G0918G8395G8396G8397G8398G8399G8400G8401G8404G8405G8410G8415G8416G8417G8418G8419G8420G8421G8422G8427G8428G8430G8431G8432G8433G8442G8450G8451G8452G8458G8460G8461G8465G8473

STATUS M

HCPCS Codes ModifierG8474G8475G8476G8477G8478G8482G8483G8484G8485G8486G8487G8489G8490G8491G8494G8495G8496G8497G8498G8499G8500G8506G8509G8510G8511G8530G8531G8532G8535G8536G8539G8540G8541G8542G8543G8544G8545G8548G8549

January 30, 2015© 2015 Copyright, CGS Administrators, LLC. PAGE 29

Bundled, Inactive, and Non-Payable Codes for 2015: Medicare Physician Fee Schedule Database

Modifier 26 is a CPT modifier, and modifier TC is a HCPCS modifier.

HCPCS Codes ModifierG8551G8569G8570G8571G8572G8573G8574G8575G8576G8577G8578G8598G8599G8600G8601G8602G8627G8628G8633G8634G8635G8645G8646G8647G8648G8649G8650G8651G8652G8653G8654G8655G8656G8657G8658G8659G8660G8661G8662

HCPCS Codes ModifierG8663G8664G8665G8666G8667G8668G8669G8670G8671G8672G8673G8674G8694G8696G8697G8698G8708G8709G8710G8711G8712G8713G8714G8717G8718G8720G8721G8722G8723G8724G8725G8726G8728G8730G8731G8732G8733G8734G8735

HCPCS Codes ModifierG8749G8752G8753G8754G8755G8756G8757G8758G8759G8761G8762G8765G8783G8784G8785G8797G8798G8806G8807G8808G8809G8810G8811G8815G8816G8817G8818G8825G8826G8833G8834G8838G8839G8840G8841G8842G8843G8844G8845

HCPCS Codes ModifierG8846G8848G8849G8850G8851G8852G8853G8854G8855G8856G8857G8858G8861G8863G8864G8865G8866G8867G8868G8869G8870G8871G8872G8873G8874G8875G8876G8877G8878G8879G8880G8881G8882G8883G8884G8885G8898G8899G8900

STATUS M

January 30, 2015© 2015 Copyright, CGS Administrators, LLC. PAGE 30

Bundled, Inactive, and Non-Payable Codes for 2015: Medicare Physician Fee Schedule Database

Modifier 26 is a CPT modifier, and modifier TC is a HCPCS modifier.

HCPCS Codes ModifierG8902G8903G8906G8923G8924G8925G8926G8927G8928G8929G8934G8935G8936G8937G8938G8939G8940G8941G8942G8944G8946G8947G8948G8950G8951G8952G8953G8955G8956G8958G8959G8960G8961G8962G8963G8964G8965G8966G8967

HCPCS Codes ModifierG8968G8969G8970G8971G8972G8973G8974G8975G8976G8977G9063G9064G9065G9066G9067G9068G9069G9070G9071G9072G9073G9074G9075G9077G9078G9079G9080G9083G9084G9085G9086G9087G9088G9089G9090G9091G9092G9093G9094

HCPCS Codes ModifierG9095G9096G9097G9098G9099G9100G9101G9102G9103G9104G9105G9106G9107G9108G9109G9110G9111G9112G9113G9114G9115G9116G9117G9123G9124G9125G9126G9128G9129G9130G9131G9132G9133G9134G9135G9136G9137G9138G9139

HCPCS Codes ModifierG9188G9189G9190G9191G9192G9196G9197G9198G9203G9204G9205G9206G9207G9208G9209G9210G9211G9212G9213G9217G9219G9222G9223G9225G9226G9227G9228G9229G9230G9231G9232G9233G9234G9235G9236G9237G9238G9239G9240

STATUS M

January 30, 2015© 2015 Copyright, CGS Administrators, LLC. PAGE 31

Bundled, Inactive, and Non-Payable Codes for 2015: Medicare Physician Fee Schedule Database

Modifier 26 is a CPT modifier, and modifier TC is a HCPCS modifier.

HCPCS Codes ModifierG9241G9242G9243G9244G9245G9246G9247G9250G9251G9254G9255G9256G9257G9258G9259G9260G9261G9262G9263G9264G9265G9266G9267G9268G9269G9270G9273G9274G9275G9276G9277G9278G9279G9280G9281G9282G9283G9284G9285

HCPCS Codes ModifierG9286G9287G9288G9289G9290G9291G9292G9293G9294G9295G9296G9297G9298G9299G9300G9301G9302G9303G9304G9305G9306G9307G9308G9309G9310G9311G9312G9313G9314G9315G9316G9317G9318G9319G9320G9321G9322G9323G9324

HCPCS Codes ModifierG9325G9326G9327G9328G9329G9340G9341G9342G9343G9344G9345G9346G9347G9348G9349G9350G9351G9352G9353G9354G9355G9356G9357G9358G9359G9360G9361G9362G9363G9364G9365G9366G9367G9368G9369G9370G9376G9377G9378

HCPCS Codes ModifierG9379G9380G9381G9382G9383G9384G9385G9386G9389G9390G9391G9392G9393G9394G9395G9396G9399G9400G9401G9402G9403G9404G9405G9406G9407G9408G9409G9410G9411G9412G9413G9414G9415G9416G9417G9418G9419G9420G9421

STATUS M

January 30, 2015© 2015 Copyright, CGS Administrators, LLC. PAGE 32

Bundled, Inactive, and Non-Payable Codes for 2015: Medicare Physician Fee Schedule Database

Modifier 26 is a CPT modifier, and modifier TC is a HCPCS modifier.

HCPCS Codes ModifierG9422G9423G9424G9425G9426G9427G9428G9429G9430G9431G9432G9433G9434G9435G9436G9437G9438G9439G9440G9441G9442G9443G9448G9449G9450G9451G9452G9453G9454G9455G9456G9457G9458G9459G9460G9461G9462G9463G9464

HCPCS Codes ModifierG9465G9466G9467G9468G9469G9470G9471G9472

STATUS M

January 30, 2015© 2015 Copyright, CGS Administrators, LLC. PAGE 33Modifier 26 is a CPT modifier, and

modifier TC is a HCPCS modifier.

STATUS N Status N are always non-covered. There are no RVUs or payment amounts for these codes, and separate payment is not made.

CPT Codes Modifier2252622527372164384248160583006164061641616426576065765657676577169090697107426374263 2674263 TC7639076390 2676390 TC7835078350 2678350 TC783517860978609 2678609 TC800508691086911880008800588007

CPT Codes Modifier88012880148801688020880258802788028880298803688037880408804588099908759087690882920159231092314923409234192342923709255192559925609259092591925929259392594925959366893895

CPT Codes Modifier93895 2693895 TC9611096155978109781197813978149894398966989679896898969990269902799075991729917399174991889938199382993839938499385993869938799391993929939399394993959939699397

CPT Codes Modifier9940199402994039940499408994099941199412994209942999441994429944399444994500085T0188T0189T

January 30, 2015© 2015 Copyright, CGS Administrators, LLC. PAGE 34

Bundled, Inactive, and Non-Payable Codes for 2015: Medicare Physician Fee Schedule Database

Modifier 26 is a CPT modifier, and modifier TC is a HCPCS modifier.

HCPCS Codes ModifierA0888A4210A4250A4252A4261A4490A4495A4500A4510A4520A4554A4575A4627A4670A6000A6413A6530A6533A6534A6535A6536A6537A6538A6539A6540A6541A6544A6549A9270A9273A9275A9276A9277A9278A9280A9281A9282A9283A9300

HCPCS Codes ModifierD0120D0140D0145D0160D0170D0171D0180D0190D0191D0273D0363D0364D0365D0366D0367D0368D0369D0370D0371D0380D0381D0382D0383D0384D0385D0386D0391D0393D0394D0395D0415D0417D0418D0425D0470D0486D1110D1120D1206

HCPCS Codes ModifierD1208D1310D1320D1330D1351D1353D1555D2140D2150D2160D2161D2330D2331D2332D2335D2390D2391D2392D2393D2394D2410D2420D2430D2510D2520D2530D2542D2543D2544D2610D2620D2630D2642D2643D2644D2650D2651D2652D2662

HCPCS Codes ModifierD2663D2664D2710D2712D2720D2721D2722D2740D2750D2751D2752D2780D2781D2782D2783D2790D2791D2792D2794D2799D2910D2915D2920D2921D2929D2930D2931D2932D2933D2934D2940D2941D2949D2950D2951D2952D2953D2954D2955

STATUS N

January 30, 2015© 2015 Copyright, CGS Administrators, LLC. PAGE 35

Bundled, Inactive, and Non-Payable Codes for 2015: Medicare Physician Fee Schedule Database

Modifier 26 is a CPT modifier, and modifier TC is a HCPCS modifier.

HCPCS Codes ModifierD2957D2960D2961D2962D2971D2975D2980D2981D2982D2983D2990D3110D3120D3220D3221D3222D3230D3240D3310D3320D3330D3331D3332D3333D3346D3347D3348D3351D3352D3353D3355D3356D3357D3410D3421D3425D3426D3427D3428

HCPCS Codes ModifierD3429D3430D3431D3432D3450D3470D3910D3920D3950D4230D4231D4240D4241D4245D4249D4261D4265D4266D4267D4274D4275D4276D4320D4321D4341D4342D4910D4920D4921D4999D5110D5120D5130D5140D5211D5212D5213D5214D5225

HCPCS Codes ModifierD5226D5281D5410D5411D5421D5422D5510D5520D5610D5620D5630D5640D5650D5660D5670D5671D5710D5711D5720D5721D5730D5731D5740D5741D5750D5751D5760D5761D5810D5811D5820D5821D5850D5851D5860D5861D5862D5863D5864

HCPCS Codes ModifierD5865D5866D5867D5875D5899D5986D5991D6012D6013D6051D6053D6054D6056D6057D6058D6059D6060D6061D6062D6063D6064D6065D6066D6067D6068D6069D6070D6071D6072D6073D6074D6075D6076D6077D6078D6079D6091D6092D6093

STATUS N

January 30, 2015© 2015 Copyright, CGS Administrators, LLC. PAGE 36

Bundled, Inactive, and Non-Payable Codes for 2015: Medicare Physician Fee Schedule Database

Modifier 26 is a CPT modifier, and modifier TC is a HCPCS modifier.

HCPCS Codes ModifierD6094D6110D6111D6112D6113D6114D6115D6116D6117D6190D6194D6205D6210D6211D6212D6214D6240D6241D6242D6245D6250D6251D6252D6253D6545D6548D6549D6600D6601D6602D6603D6604D6605D6606D6607D6608D6609D6610D6611

HCPCS Codes ModifierD6612D6613D6614D6615D6624D6634D6710D6720D6721D6722D6740D6750D6751D6752D6780D6781D6782D6783D6790D6791D6792D6793D6794D6930D6940D6950D6975D6980D6985D6999D7270D7272D7280D7282D7290D7292D7293D7294D7311

HCPCS Codes ModifierD7871D7951D7952D7953D7963D7997D7998D8010D8020D8030D8040D8050D8060D8070D8080D8090D8210D8220D8660D8670D8680D8690D8691D8692D8693D8694D8999D9120D9612D9910D9911D9920D9931D9941D9942D9970D9971D9972D9973

HCPCS Codes ModifierD9974D9975G0122G0122 26G0122 TCG0219G0219 26G0219 TCG0235G0235 26G0235 TCG0252G0252 26G0252 TCG0255G0255 26G0255 TCG0282G0295G0428G9013G9014G9016G9147J3520J3535J3570J7300J7301J7302J7303J7304J8499J8515M0075M0076M0100M0300M0301

STATUS N

January 30, 2015© 2015 Copyright, CGS Administrators, LLC. PAGE 37

Bundled, Inactive, and Non-Payable Codes for 2015: Medicare Physician Fee Schedule Database

Modifier 26 is a CPT modifier, and modifier TC is a HCPCS modifier.

HCPCS Codes ModifierP2031Q0144T4521T4522T4523T4524T4525T4526T4527T4528T4529T4530T4531T4532T4533T4534T4535T4536T4537T4538T4539T4540T4543T4544V2025V2702V2787V2788V5008V5010V5011V5014V5020V5030V5040V5050V5060V5070V5080

HCPCS Codes ModifierV5090V5095V5100V5110V5120V5130V5140V5150V5160V5170V5180V5190V5200V5210V5220V5230V5240V5241V5242V5243V5244V5245V5246V5247V5248V5249V5250V5251V5252V5253V5254V5255V5256V5257V5258V5259V5260V5261V5262

HCPCS Codes ModifierV5263V5264V5265V5266V5267V5268V5269V5270V5271V5272V5273V5274V5275V5281V5282V5283V5284V5285V5286V5287V5288V5289V5290V5298V5336V5362V5363V5364

STATUS N

January 30, 2015© 2015 Copyright, CGS Administrators, LLC. PAGE 38Modifier 26 is a CPT modifier, and

modifier TC is a HCPCS modifier.

HCPCS Codes ModifierA4211A4212A4220A4253A4256A4258A4259A4265A4301A4305A4306A4310A4311A4312A4313A4314A4315A4316A4320A4322A4326A4327A4328A4330A4335A4338A4340A4344A4346A4351A4352A4354A4355A4356

HCPCS Codes ModifierA4357A4358A4361A4362A4364A4367A4397A4398A4399A4400A4402A4404A4455A4465A4470A4480A4556A4557A4558A4649A5051A5052A5053A5054A5055A5061A5062A5063A5071A5072A5073A5081A5082A5093

HCPCS Codes ModifierA5102A5105A5112A5113A5114A5121A5122A5126A5131A6154A6196A6197A6198A6199A6203A6204A6205A6206A6207A6208A6209A6210A6211A6212A6213A6214A6215A6216A6217A6218A6219A6220A6221A6222

HCPCS Codes ModifierA6223A6224A6228A6229A6230A6234A6235A6236A6237A6238A6239A6240A6241A6242A6243A6244A6245A6246A6247A6248A6250A6251A6252A6253A6254A6255A6256A6257A6258A6259A6260A6261A6262A6266

STATUS P Status P are bundled/excluded codes. There are no RVUs or payment amounts for these codes, and separate payment is not made.

January 30, 2015© 2015 Copyright, CGS Administrators, LLC. PAGE 39

Bundled, Inactive, and Non-Payable Codes for 2015: Medicare Physician Fee Schedule Database

Modifier 26 is a CPT modifier, and modifier TC is a HCPCS modifier.

HCPCS Codes ModifierA6402A6403A6404V2520

STATUS P

January 30, 2015© 2015 Copyright, CGS Administrators, LLC. PAGE 40Modifier 26 is a CPT modifier, and

modifier TC is a HCPCS modifier.

HCPCS Codes ModifierG8978G8979G8980G8981G8982G8983G8984G8985G8986G8987G8988G8989G8990G8991G8992G8993G8994G8995G8996G8997G8998G8999G9158G9159G9160G9161G9162G9163G9164G9165G9166G9167G9168G9169

HCPCS Codes ModifierG9170G9171G9172G9173G9174G9175G9176G9186

STATUS QStatus Q codes are therapy functional reporting codes. There are no RVUs or payment amounts for these codes, and separate payment is not made.

January 30, 2015© 2015 Copyright, CGS Administrators, LLC. PAGE 41Modifier 26 is a CPT modifier, and

modifier TC is a HCPCS modifier.

CPT Codes Modifier11055110561105711719119201192111922119501195111952119541197615775157761578815789157921582415825158261582815829158301587615877158781587917380228572286222865304003041030420

CPT Codes Modifier30430304353045032491339353394535475364683721538205382063824038241408404084240843408444084541820418214182241823418284183041850418704187241874441324413344135441364713547136

CPT Codes Modifier4855459840598415985059851598525985559856598575986661630616356722169300699907155571555 2671555 TC7215972159 2672159 TC7322573225 2673225 TC7372573725 2673725 TC7418574185 2674185 TC7760077600 2677600 TC77605

CPT Codes Modifier77605 2677605 TC7761077610 2677610 TC7761577615 2677615 TC7762077620 2677620 TC9047390474908469084790849939829690497026975459754699455994560275T

STATUS RStatus R have restricted coverage, and special instructions may apply. Refer to the CMS National Coverage Determinations (NCDs) and the CGS website and LCDs for more information.

January 30, 2015© 2015 Copyright, CGS Administrators, LLC. PAGE 42

Bundled, Inactive, and Non-Payable Codes for 2015: Medicare Physician Fee Schedule Database

Modifier 26 is a CPT modifier, and modifier TC is a HCPCS modifier.

HCPCS Codes ModifierA4890D0150D0240D0250D0260D0270D0272D0274D0277D0416D0421D0431D0460D0472D0473D0474D0475D0476D0477D0478D0479D0480D0481D0482D0483D0484D0485D0502D0601D0602D0603D0999D1510D1515D1520D1525D1550D1999D2970

HCPCS Codes ModifierD2999D3460D3999D4260D4263D4264D4268D4270D4273D4277D4278D4355D4381D5911D5912D5951D5983D5984D5985D5987D6052D6920D7111D7140D7210D7220D7230D7240D7241D7250D7260D7261D7283D7288D7291D7321D7511D7521D7940

HCPCS Codes ModifierD9110D9230D9248D9630D9930D9940D9950D9951D9952G0127G0128G0245G0246G0247G0248G0249G0250G0276G0409G9148G9149G9150G9151G9152G9153G9156V5299

STATUS R

January 30, 2015© 2015 Copyright, CGS Administrators, LLC. PAGE 43Modifier 26 is a CPT modifier, and

modifier TC is a HCPCS modifier.

CPT Codes Modifier365913659236598947609476196523

STATUS TStatus T are only paid separately if there are no other physician services payable under the MPFS billed on the same date of service by the same provider. If any other services payable under the MPFS are billed on the same date of service by the same provider, these services are bundled into payment for the physician service.

HCPCS Codes ModifierG0117G0118

January 30, 2015© 2015 Copyright, CGS Administrators, LLC. PAGE 44Modifier 26 is a CPT modifier, and

modifier TC is a HCPCS modifier.

CPT Codes Modifier32850339303394036415471334855050300774247742578267782688004780048800518005380061800698007480076801508015580156801578015880159801628016480168801698017080171801738017580176

CPT Codes Modifier80177801788018080183801848018580186801888019080192801948019580197801988019980200802018020280203802998040080402804068040880410804128041480415804168041780418804208042280424

CPT Codes Modifier80426804288043080432804348043580436804388043981000810018100281003810058100781015810208102581050810998116181200812018120281203812058120681207812088120981210812118121281213

CPT Codes Modifier81214812158121681217812208122181222812238122481225812268122781228812298123581240812418124281243812448124581250812518125281253812548125581256812578126081261812628126381264

STATUS X

Status X are statutorily excluded from coverage under the physician fee schedule. These codes represent items or services that are not included in the statutory definition of “physician services” for fee schedule purposes. There are no RVUs or payment amounts for these codes, and separate payment is not made under the physician fee schedule. Status X codes may be payable under a different fee schedule; this list includes codes that are payable under the ambulance fee schedule and clinical laboratory fee schedule.

January 30, 2015© 2015 Copyright, CGS Administrators, LLC. PAGE 45

Bundled, Inactive, and Non-Payable Codes for 2015: Medicare Physician Fee Schedule Database

Modifier 26 is a CPT modifier, and modifier TC is a HCPCS modifier.

CPT Codes Modifier812658126681267812688127081275812808128181282812878129081291812928129381294812958129681297812988129981300813018130281303813048131081315813168131781318813198132181322813238132481325813268133081331

CPT Codes Modifier813328134081341813428135081355813708137181372813738137481375813768137781378813798138081381813828138381400814018140281403814048140581406814078140881479815048150782009820108201382016820178202482030

CPT Codes Modifier820408204282043820448204582075820858208882103821048210582106821078210882120821278212882131821358213682139821408214382150821548215782160821638216482172821758218082190822328223982240822478224882252

CPT Codes Modifier822618227082271822728227482286823008230682308823108233082331823408235582360823658237082373823748237582376823788237982380823828238382384823878239082397824158243582436824388244182465824808248282485

STATUS X

January 30, 2015© 2015 Copyright, CGS Administrators, LLC. PAGE 46

Bundled, Inactive, and Non-Payable Codes for 2015: Medicare Physician Fee Schedule Database

Modifier 26 is a CPT modifier, and modifier TC is a HCPCS modifier.

CPT Codes Modifier824868248782488824898249182492824958250782523825258252882530825338254082541825428254382544825508255282553825548256582570825758258582595826008260782608826108261582626826278263382634826388265282656

CPT Codes Modifier826578265882664826688267082671826728267782679826938269682705827108271582725827268272882731827358274682747827578275982760827758277682777827848278582787828008280382805828108282082930829388294182943

CPT Codes Modifier829458294682947829488295082951829528295582960829628296382965829778297882979829858300183002830038300983010830128301383014830158301883020830218302683030830338303683037830458305083051830608306583068

CPT Codes Modifier830698307083080830888309083150834918349783498834998350083505835168351883519835208352583527835288354083550835708358283586835938360583615836258363083631836328363383655836618366283663836648367083690

STATUS X

January 30, 2015© 2015 Copyright, CGS Administrators, LLC. PAGE 47

Bundled, Inactive, and Non-Payable Codes for 2015: Medicare Physician Fee Schedule Database

Modifier 26 is a CPT modifier, and modifier TC is a HCPCS modifier.

CPT Codes Modifier836958369883700837018370483718837198372183727837358377583785837888378983825838358385783861838648387283873838748387683880838838388583915839168391883919839218393083935839378394583950839518397083986

CPT Codes Modifier839878399283993840308403584060840618406684075840788408084081840858408784100841058410684110841128411984120841268413284133841348413584138841408414384144841458414684150841528415384154841558415684157

CPT Codes Modifier841608416384165841668418184182842028420384206842078421084220842288423384234842358423884244842528425584260842708427584285842958430084302843058430784311843158437584376843778437884379843928440284403

CPT Codes Modifier844258443084431844328443684437844398444284443844458444684449844508446084466844788447984480844818448284484844858448884490845108451284520845258454084545845508456084577845788458084583845858458684588

STATUS X

January 30, 2015© 2015 Copyright, CGS Administrators, LLC. PAGE 48

Bundled, Inactive, and Non-Payable Codes for 2015: Medicare Physician Fee Schedule Database

Modifier 26 is a CPT modifier, and modifier TC is a HCPCS modifier.

CPT Codes Modifier845908459184597846008462084630846818470284703847048483084999850028500485007850088500985013850148501885025850278503285041850448504585046850488504985055851308517085175852108522085230852408524485245

CPT Codes Modifier852468524785250852608527085280852908529185292852938530085301853028530385305853068530785335853378534585347853488536085362853668537085378853798538085384853858539085397854008541085415854208542185441

CPT Codes Modifier854458546085461854758552085525855308553685540855478554985555855578557685597855988561085611856128561385635856518565285660856708567585705857308573285810859998600086001860038600586021860228602386038

CPT Codes Modifier860398606086063861408614186146861478614886152861558615686157861608616186162861718618586200862158622586226862358624386255862568627786280862948630086301863048630586308863098631086316863178631886320

STATUS X

January 30, 2015© 2015 Copyright, CGS Administrators, LLC. PAGE 49

Bundled, Inactive, and Non-Payable Codes for 2015: Medicare Physician Fee Schedule Database

Modifier 26 is a CPT modifier, and modifier TC is a HCPCS modifier.

CPT Codes Modifier863258632786329863318633286334863358633686337863408634186343863448635286353863558635686357863598636086361863678637686378863828638486386864038640686430864318648086481865908659286593866028660386606

CPT Codes Modifier866098661186612866158661786618866198662286625866288663186632866358663886641866448664586648866518665286653866548665886663866648666586666866688667186674866778668286684866878668886689866928669486695

CPT Codes Modifier866968669886701867028670386704867058670686707867088670986710867118671386717867208672386727867298673286735867388674186744867478675086753867568675786759867628676586768867718677486777867788678086784

CPT Codes Modifier867878678886789867908679386800868038680486805868068680786808868128681386816868178682186822868258682686828868298683086831868328683386834868358684986850868608687086880868858688686890868918690086901

STATUS X

January 30, 2015© 2015 Copyright, CGS Administrators, LLC. PAGE 50

Bundled, Inactive, and Non-Payable Codes for 2015: Medicare Physician Fee Schedule Database

Modifier 26 is a CPT modifier, and modifier TC is a HCPCS modifier.

CPT Codes Modifier869028690486905869068692086921869228692386927869308693186932869408694186945869508696086965869708697186972869758697686977869788698586999870038701587040870458704687070870718707387075870768707787081

CPT Codes Modifier870848708687088871018710287103871068710787109871108711687118871408714387147871498715087152871538715887164871668716887169871728717687177871818718487185871868718787188871908719787205872068720787209

CPT Codes Modifier872108722087230872508725287253872548725587260872658726787269872708727187272872738727487275872768727787278872798728087281872838728587290872998730087301873058732087324873278732887329873328733587336

CPT Codes Modifier873378733887339873408734187350873808738587389873908739187400874208742587427874308744987450874518747087471874728747587476874778748087481874828748587486874878749087491874928749387495874968749787498

STATUS X

January 30, 2015© 2015 Copyright, CGS Administrators, LLC. PAGE 51

Bundled, Inactive, and Non-Payable Codes for 2015: Medicare Physician Fee Schedule Database

Modifier 26 is a CPT modifier, and modifier TC is a HCPCS modifier.

CPT Codes Modifier875008750187502875038751087511875128751587516875178752087521875228752587526875278752887529875308753187532875338753487535875368753787538875398754087541875428755087551875528755587556875578756087561

CPT Codes Modifier875628758087581875828759087591875928763187632876338764087641876508765187652876538766087661877978779887799878008780187802878038780487807878088780987810878508788087899879008790187902879038790487905

CPT Codes Modifier879068791087912879998813088140881428814388147881488815088152881538815488155881648816588166881678817488175882308823388235882378823988240882418824588248882498826188262882638826488267882698827188272

CPT Codes Modifier882738827488275882808828388285882898837188372887208873888740887418874989050890518905589060891258916089190892508925189253892548925589257892588925989260892618926489268892728928089281892908929189300

STATUS X

January 30, 2015© 2015 Copyright, CGS Administrators, LLC. PAGE 52

Bundled, Inactive, and Non-Payable Codes for 2015: Medicare Physician Fee Schedule Database

Modifier 26 is a CPT modifier, and modifier TC is a HCPCS modifier.

CPT Codes Modifier893108932089321893228932589329893308933189335893428934389344893468935289353893548935689398902849037890630906449065190653906549065590656906579066090661906629066490666906679066890669906709067290673

CPT Codes Modifier9068590686906879068890732907399074090743907449074690747909409098990993925589637699190991919919299360996059960699607

STATUS X

HCPCS Codes ModifierA4236A4244A4245A4246A4247A4248A4255A4257A4280A4281A4282A4283A4284A4285A4286A4290A4321A4331A4332A4333A4334A4336A4349A4353A4360A4363A4366A4368A4369A4371A4372A4373A4375A4376A4377A4378A4379A4380A4381

HCPCS Codes ModifierA0382A0384A0392A0394A0396A0398A0420A0422A0424A0425A0426A0427A0428A0429A0430A0431A0432A0433A0434A0435A0436A0999A4206A4207A4208A4209A4213A4215A4216A4217A4218A4221A4222A4223A4230A4231A4233A4234A4235

January 30, 2015© 2015 Copyright, CGS Administrators, LLC. PAGE 53

Bundled, Inactive, and Non-Payable Codes for 2015: Medicare Physician Fee Schedule Database

Modifier 26 is a CPT modifier, and modifier TC is a HCPCS modifier.

HCPCS Codes ModifierA4382A4383A4384A4385A4387A4388A4389A4390A4391A4392A4393A4394A4395A4396A4405A4406A4407A4408A4409A4410A4411A4412A4413A4414A4415A4416A4417A4418A4419A4420A4421A4422A4423A4424A4425A4426A4427A4428A4429

HCPCS Codes ModifierA4430A4431A4432A4433A4434A4435A4450A4452A4456A4458A4459A4461A4463A4481A4483A4559A4561A4562A4565A4595A4600A4601A4602A4604A4605A4606A4608A4611A4612A4613A4614A4615A4616A4617A4618A4619A4620A4623A4624

HCPCS Codes ModifierA4625A4626A4628A4629A4630A4633A4634A4635A4636A4637A4638A4639A4640A4648A4650A4651A4652A4653A4657A4660A4663A4671A4672A4673A4674A4680A4690A4706A4707A4708A4709A4714A4719A4720A4721A4722A4723A4724A4725

HCPCS Codes ModifierA4726A4728A4730A4736A4737A4740A4750A4755A4760A4765A4766A4770A4771A4772A4773A4774A4802A4860A4870A4911A4913A4918A4927A4928A4929A4930A4931A4932A5056A5057A5083A5120A5200A5500A5501A5503A5504A5505A5506

STATUS X

January 30, 2015© 2015 Copyright, CGS Administrators, LLC. PAGE 54

Bundled, Inactive, and Non-Payable Codes for 2015: Medicare Physician Fee Schedule Database

Modifier 26 is a CPT modifier, and modifier TC is a HCPCS modifier.

HCPCS Codes ModifierA5507A5508A5510A5512A5513A6010A6011A6021A6022A6023A6024A6025A6231A6232A6233A6407A6410A6411A6412A6441A6442A6443A6444A6445A6446A6447A6448A6449A6450A6451A6452A6453A6454A6455A6456A6457A6501A6502A6503

HCPCS Codes ModifierA6504A6505A6506A6507A6508A6509A6510A6511A6512A6513A6531A6532A6545A6550A7000A7001A7002A7003A7004A7005A7006A7007A7008A7009A7010A7011A7012A7013A7014A7015A7016A7017A7018A7020A7025A7026A7027A7028A7029

HCPCS Codes ModifierA7030A7031A7032A7033A7034A7035A7036A7037A7038A7039A7040A7041A7042A7043A7044A7045A7046A7047A7048A7501A7502A7503A7504A7505A7506A7507A7508A7509A7520A7521A7522A7523A7524A7525A7526A7527A8000A8001A8002

HCPCS Codes ModifierA8003A8004A9155A9284A9520A9575A9576A9577A9578A9579A9581A9582A9583A9584A9585A9604A9606A9698A9900A9901A9999G0008G0009G0010G0027G0103G0123G0129G0143G0144G0145G0147G0148G0151G0152G0153G0154G0155G0156

STATUS X

January 30, 2015© 2015 Copyright, CGS Administrators, LLC. PAGE 55

Bundled, Inactive, and Non-Payable Codes for 2015: Medicare Physician Fee Schedule Database

Modifier 26 is a CPT modifier, and modifier TC is a HCPCS modifier.

HCPCS Codes ModifierG0175G0176G0177G0302G0303G0304G0305G0306G0307G0328G0333G0337G0378G0379G0380G0381G0382G0383G0384G0390G0410G0411G0431G0432G0433G0434G0435G0463G0464G0466G0467G0468G0469G0470G0471G0472G3001G6030G6031

HCPCS Codes ModifierG6032G6034G6035G6036G6037G6038G6039G6040G6041G6042G6043G6044G6045G6046G6047G6048G6049G6050G6051G6052G6053G6054G6055G6056G6057G6058G8907G8908G8909G8910G8911G8912G8913G8914G8915G8916G8917G8918G9001

HCPCS Codes ModifierG9002G9003G9004G9005G9006G9007G9008G9009G9010G9011G9012G9017G9018G9019G9020G9033G9034G9035G9036G9140G9143J7190J7191J7192J7193J7194J7195J7197J7198J7199J7500J7501J7504J7505J7506J7509J7510J7599P2028

HCPCS Codes ModifierP2029P2033P2038P3000P9023P9031P9032P9033P9034P9035P9036P9037P9038P9039P9040P9041P9043P9044P9045P9046P9047P9048P9050P9051P9052P9053P9054P9055P9056P9057P9058P9059P9060P9603P9604P9612P9615Q0111Q0112

STATUS X

January 30, 2015© 2015 Copyright, CGS Administrators, LLC. PAGE 56

Bundled, Inactive, and Non-Payable Codes for 2015: Medicare Physician Fee Schedule Database

Modifier 26 is a CPT modifier, and modifier TC is a HCPCS modifier.

HCPCS Codes ModifierQ0113Q0114Q0115Q0163Q0164Q0166Q0167Q0169Q0173Q0174Q0175Q0177Q0180Q0181Q1004Q1005Q2034Q2035Q2036Q2037Q2038Q2039Q3014Q4001Q4002Q4003Q4004Q4005Q4006Q4007Q4008Q4009Q4010Q4011Q4012Q4013Q4014Q4015Q4016

HCPCS Codes ModifierQ4017Q4018Q4019Q4020Q4021Q4022Q4023Q4024Q4025Q4026Q4027Q4028Q4029Q4030Q4031Q4032Q4033Q4034Q4035Q4036Q4037Q4038Q4039Q4040Q4041Q4042Q4043Q4044Q4045Q4046Q4047Q4048Q4049Q4050Q4051Q4131Q4132Q4133Q4134

HCPCS Codes ModifierQ4135Q4136V2020V2100V2101V2102V2103V2104V2105V2106V2107V2108V2109V2110V2111V2112V2113V2114V2115V2118V2121V2199V2200V2201V2202V2203V2204V2205V2206V2207V2208V2209V2210V2211V2212V2213V2214V2215V2218

HCPCS Codes ModifierV2219V2220V2221V2299V2300V2301V2302V2303V2304V2305V2306V2307V2308V2309V2310V2311V2312V2313V2314V2315V2318V2319V2320V2321V2399V2410V2430V2499V2500V2501V2502V2503V2510V2511V2512V2513V2521V2522V2523

STATUS X

January 30, 2015© 2015 Copyright, CGS Administrators, LLC. PAGE 57

Bundled, Inactive, and Non-Payable Codes for 2015: Medicare Physician Fee Schedule Database

Modifier 26 is a CPT modifier, and modifier TC is a HCPCS modifier.

HCPCS Codes ModifierV2530V2531V2599V2600V2610V2615V2623V2624V2625V2626V2627V2628V2629V2630V2631V2632V2700V2710V2715V2718V2730V2744V2745V2750V2755V2756V2760V2761V2762V2770V2780V2781V2782V2783V2784V2785V2786V2790V2797

HCPCS Codes ModifierV2799

STATUS X