Appendix F: Procedure Modifier Codes
Utilize the latest Alpha Numeric HCPCS Procedure Modifier Code set.
HCPCS Procedure Modifier Code set can be downloaded online at CMS Alpha-Numeric HCPCS Code sets.
The following table lists ambulance origin and destination modifiers that are used with transportation service codes. Use the first digit to indicate the place of origin, and the second digit to indicate the destination.
| Value | Ambulance Origin and Destination Modifier |
|---|---|
D | Diagnostic or therapeutic site other than ‘P’ or ‘H’ when these codes are used as origin codes |
E | Residential, domiciliary, custodial facility (other than a 1819 facility) |
G | Hospital-based dialysis facility (hospital or hospital-related) |
H | Hospital |
I | Site of transfer (e.g., airport or helicopter pad) between types of ambulance |
J | Non-hospital-based dialysis facility |
N | Skilled nursing facility (SNF) (1819 facility) |
P | Physician’s office (includes HMO non-hospital facility, clinic, etc.) |
R | Residence |
S | Scene of accident or acute event |
X | (Destination code only) intermediate stop at physician’s office on the way to the hospital (included HMO non-hospital facility, clinic, etc.) |