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When To Report An Modifier In CMS 1500 & Electronic Loop

Informational
(No additional payment for informational modifiers)
Modifier Description
G9 Monitored Anesthesia Care (MAC) for patient who has history of severe cardiopulmonary condition
P1 A normal healthy patient
P2 A patient with mild systemic disease
P3 A patient with severe systemic disease
P4 A patient with severe systemic disease that is a constant threat to life
P5 A moribund patient who is not expected to survive without the operation
P6 A declared brain-dead patient whose organs are being removed for donor purposes

Modifiers should be entered in item 24d following the procedure code on the CMS-1500 claim form or electronic equivalent.

Electronic:
Loop 2400/SV101-1 (HC) Service ID Qualifier
Loop 2400/SV101-2 Procedure Code
Loop 2400/SV101-3 Procedure Modifier 1
Loop 2400/SV101-4 Procedure Modifier 2
Loop 2400/SV101-5 Procedure Modifier 3
Loop 2400/SV101-6 Procedure Modifier 4

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