22 Modifiers & HCPCS Level II Practice Questions & Answers

1. 1. A physician removes a small skin lesion (a minor procedure carrying a 10-day global period) and, at the same visit, performs and documents a significant, separately identifiable evaluation of a new, unrelated complaint. Which modifier is used, and to which code is it appended?

   • A.Modifier 59, appended to the lesion removal code
   • B.Modifier 25, appended to the lesion removal code
   • C.Modifier 25, appended to the E/M code✓ Answer
   • D.Modifier 57, appended to the E/M code

   Modifier 25 reports a significant, separately identifiable E/M service furnished by the same provider on the same day as a procedure. Because the altered circumstance belongs to the E/M service itself, the modifier is appended to the E/M code while the procedure code is reported unchanged. Modifier 57 is reserved for the E/M visit at which the decision for major surgery is made, so it does not fit a minor procedure.

   Source: AMA CPT Appendix A (Modifiers) — modifier 25Report a problem with this question

2. 2. A surgeon evaluates a patient in the hospital and, during that visit, decides to perform a major surgical procedure (one carrying a 90-day global period) the following morning. Which modifier is appended to the E/M service?

   • A.Modifier 25
   • B.Modifier 57✓ Answer
   • C.Modifier 32
   • D.Modifier 24

   Modifier 57 identifies the E/M service at which the decision to perform major surgery was made, reported on the day of or the day before that surgery. The preoperative visit would otherwise fall inside the surgical package and go unpaid, so the modifier is what pulls it out of the global period. Modifier 25 handles the same-day E/M when the associated procedure is minor, which is the distinction candidates most often miss.

   Source: AMA CPT Appendix A (Modifiers) — modifier 57Report a problem with this question

3. 3. Three weeks after performing a knee replacement (90-day global period), the same surgeon sees the patient for an acute, unrelated sinus infection and provides an office visit. Which modifier is appended to that E/M service?

   • A.Modifier 58
   • B.Modifier 24✓ Answer
   • C.Modifier 25
   • D.Modifier 79

   Modifier 24 reports an unrelated E/M service furnished by the same physician during the postoperative period of a prior procedure; it tells the payer the visit is not routine follow-up care already paid inside the global package. Modifier 79 also concerns unrelated care during a global period but applies to a procedure, not to an E/M service, and modifier 25 concerns an E/M on the same day as a procedure.

   Source: AMA CPT Appendix A (Modifiers) — modifier 24Report a problem with this question

4. 4. Two procedures performed in the same session are subject to a procedure-to-procedure bundling edit, but the operative note shows they were performed on separate lesions through separate incisions. No more specific modifier describes the circumstance. How is the distinction reported?

   • A.Modifier 51 appended to the primary procedure
   • B.Modifier 22 appended to both codes
   • C.Modifier 59 appended to the primary (Column 1) code
   • D.Modifier 59 appended to the secondary (Column 2) code of the edit pair✓ Answer

   Modifier 59 means distinct procedural service: services that are ordinarily bundled together were, on this occasion, genuinely separate — a different session, site or organ system, separate incision or excision, separate lesion, or separate injury. It belongs on the component (Column 2) code of the edit pair, and because its meaning is so broad it is treated as the modifier of last resort, used only when no more descriptive modifier fits.

   Source: National Correct Coding Initiative Policy Manual — use of modifier 59; AMA CPT Appendix AReport a problem with this question

5. 5. The same bundled code pair is reported for one patient on one date, but documentation shows the second service was furnished at a separate patient encounter later that day. Which modifier best reports the reason the services were distinct?

   • A.Modifier 76
   • B.Modifier 91
   • C.Modifier 59
   • D.Modifier XE✓ Answer

   XE identifies a service that is distinct because it occurred during a separate encounter. The X{EPSU} set subdivides the meaning of modifier 59 into specific reasons — separate encounter, separate practitioner, separate structure, and unusual non-overlapping service — so when one of them fits, the specific subset is the better choice and 59 remains the fallback. Modifier 91 applies to repeated clinical laboratory tests and 76 to a repeat of the same service by the same provider.

   Source: National Correct Coding Initiative Policy Manual — X{EPSU} modifiers (XE, XP, XS, XU)Report a problem with this question

6. 6. Why are modifier 51 and modifier 59 not interchangeable?

   • A.Modifier 51 reports several separately payable procedures performed in the same session, while modifier 59 reports a service that would ordinarily be bundled into another but was distinct on this occasion✓ Answer
   • B.They carry the same meaning; payers simply prefer one or the other
   • C.Modifier 51 releases bundling edits while modifier 59 only reduces the payment
   • D.Modifier 51 is appended to the primary procedure and modifier 59 is appended to add-on codes

   Modifier 51 says only that more than one procedure was performed at the same session and is appended to the lesser or subsequent procedures — never to the primary procedure, to add-on codes, or to codes designated as exempt from it. It says nothing about bundling. Modifier 59 exists specifically to show that an edit-paired service was genuinely separate, so using 51 where an edit exists will not resolve the edit, and using 59 where no edit exists misrepresents the relationship between the services.

   Source: AMA CPT Appendix A (Modifiers) — modifiers 51 and 59Report a problem with this question

7. 7. A procedure whose code descriptor describes a unilateral service is performed on both sides of the body during the same session. What does CPT instruct?

   • A.Report the code once with modifier 50✓ Answer
   • B.Report the code once with modifier 51
   • C.Report the code twice and append modifier 50 to the second line
   • D.Report the code twice, once with LT and once with RT, because LT and RT are what establish that the service was bilateral

   Modifier 50 carries the meaning 'the same procedure was performed bilaterally at the same session,' so CPT's instruction is to report the code a single time with modifier 50 rather than as two separate lines. LT and RT only identify which side was treated; by themselves they state laterality, not that a bilateral service was furnished. Modifier 50 is also not appended to codes whose descriptors already include a bilateral service.

   Source: AMA CPT Appendix A (Modifiers) — modifier 50 and CPT bilateral procedure reporting instructionReport a problem with this question

8. 8. In a hospital operating room, after general anesthesia has been induced, the surgeon terminates the planned procedure because the patient becomes hemodynamically unstable. Which modifier does the SURGEON report on the procedure code?

   • A.Modifier 52
   • B.Modifier 53✓ Answer
   • C.Modifier 73
   • D.Modifier 74

   Modifier 53 means the procedure was started and then discontinued because of extenuating circumstances or a threat to the patient's well-being, which is exactly this scenario. Modifier 52 has a different meaning — a service the provider electively reduced or partially eliminated — and does not describe a termination for safety. Modifiers 73 and 74 belong to facility claims from an ASC or hospital outpatient department: 73 when the case is cancelled before anesthesia is administered and 74 after anesthesia has been administered or the procedure has begun; the physician does not use them.

   Source: AMA CPT Appendix A (Modifiers) — modifiers 52, 53, 73 and 74Report a problem with this question

9. 9. When is modifier 22 correctly appended?

   • A.Whenever a procedure runs slightly past the time it usually takes
   • B.To a procedure the provider chose to reduce
   • C.To an E/M service that required more work than usual
   • D.To a procedure code when the work substantially exceeded what that procedure typically requires, with documentation of the added intensity, time, technical difficulty, or severity of the patient's condition✓ Answer

   Modifier 22 means increased procedural services: the work actually performed was substantially greater than the work the code already contemplates. Because it asks the payer for consideration beyond the usual allowance, it carries a documentation burden — the record must explain what made the service unusually difficult, not merely that it took a little longer. It is applied to procedure codes, not to E/M services, and an electively reduced service is the opposite circumstance, reported with modifier 52.

   Source: AMA CPT Appendix A (Modifiers) — modifier 22Report a problem with this question

10. 10. A radiologist who is not employed by the hospital interprets an imaging study that was performed by hospital staff on hospital-owned equipment, and writes the report. What does the radiologist report, and what would apply if a single entity furnished both parts of the service?

    • A.Modifier 26; a single entity furnishing both parts would report the code with neither modifier✓ Answer
    • B.Modifier TC; a single entity furnishing both parts would report modifier 26
    • C.Modifier 52, because only part of the service was furnished
    • D.Modifier 26; a single entity furnishing both parts would report modifier TC

    Modifier 26 identifies the professional component — the physician's interpretation and written report — while TC identifies the technical component, meaning the equipment, supplies, and personnel. When one entity furnishes both parts, the global service is reported with neither modifier, because nothing about the service has been split. Modifier 52 is wrong here: the service was not reduced, it was divided between two billing entities.

    Source: AMA CPT Appendix A (Modifiers) — modifier 26; CMS HCPCS Level II — modifier TCReport a problem with this question

11. 11. A chest radiograph obtained in the morning is repeated the same day by a different physician to assess a change in the patient's condition. Which modifier is appended to the repeat study?

    • A.Modifier 76
    • B.Modifier 78
    • C.Modifier 77✓ Answer
    • D.Modifier 91

    Modifier 77 means a repeat procedure or service performed by another physician or qualified health professional, while modifier 76 carries the same meaning for a repeat by the same provider. The point of both is to show the identical service was necessarily performed again rather than accidentally billed twice. Modifier 91 is limited to repeated clinical diagnostic laboratory tests needed to obtain subsequent results, and modifier 78 concerns an unplanned return to the operating room.

    Source: AMA CPT Appendix A (Modifiers) — modifiers 76 and 77Report a problem with this question

12. 12. Six days after a major operation, the same surgeon unexpectedly returns the patient to the operating room to control bleeding caused by that operation. Which modifier applies, and what happens to the global period?

    • A.Modifier 58; a new global period begins
    • B.Modifier 79; a new global period begins
    • C.Modifier 78; the original global period continues and a new one does not begin✓ Answer
    • D.Modifier 76; the global period ends

    Modifier 78 means an unplanned return to the operating or procedure room for a related procedure during the postoperative period, which is what treatment of a surgical complication is. Because that return is part of managing the same surgical episode, it does not restart the global period. Modifier 58 (a staged, planned, or more extensive related procedure, which does not require a return to the operating room) and modifier 79 (an unrelated procedure by the same physician) each begin a new global period, which is the key difference among the three.

    Source: AMA CPT Appendix A (Modifiers) — modifiers 58, 78 and 79; CMS global surgery policyReport a problem with this question

13. 13. A physician assistant assists the operating surgeon throughout a procedure. Which modifier reports the assistant's service?

    • A.Modifier 66
    • B.Modifier AS✓ Answer
    • C.Modifier 62
    • D.Modifier 80

    AS is a HCPCS Level II modifier whose meaning is a physician assistant, nurse practitioner, or clinical nurse specialist acting as assistant at surgery, so it is the one that matches a non-physician practitioner. Physicians who assist use 80 (assistant surgeon), 81 (minimum assistant surgeon), or 82 (assistant surgeon when a qualified resident surgeon was not available). Modifier 62 is different in kind: it reports two surgeons acting as co-surgeons, each performing a distinct part of the same procedure and each dictating an operative report, and 66 reports a surgical team of more than two surgeons for a highly complex procedure.

    Source: CMS HCPCS Level II — modifier AS; AMA CPT Appendix A — modifiers 62, 66, 80, 81 and 82Report a problem with this question

14. 14. A surgeon performs an operation and then transfers all follow-up care to a physician in the patient's home community, who furnishes only the postoperative management. What does that second physician append to the surgical procedure code?

    • A.Modifier 55✓ Answer
    • B.Modifier 56
    • C.Modifier 24
    • D.Modifier 54

    The split-care modifiers divide the surgical package into the portions each provider actually furnished: 54 means surgical care only, 55 means postoperative management only, and 56 means preoperative management only. The physician who provides just the follow-up therefore reports the same surgical code with modifier 55, so payment follows the work performed rather than paying either provider for the whole package. Modifier 24 is unrelated: it applies to an unrelated E/M service during the postoperative period.

    Source: AMA CPT Appendix A (Modifiers) — modifiers 54, 55 and 56Report a problem with this question

15. 15. Anesthesia is administered to a patient who has severe systemic disease that is a constant threat to life. Which physical status modifier is reported?

    • A.P2
    • B.P5
    • C.P3
    • D.P4✓ Answer

    The physical status modifiers grade the patient's condition at the time anesthesia is provided: P2 is mild systemic disease, P3 is severe systemic disease, P4 is severe systemic disease that is a constant threat to life, P5 is a moribund patient not expected to survive without the operation, and P6 is a declared brain-dead organ donor. They attach to anesthesia codes because anesthesia risk rises with the patient's status. Qualifying circumstances such as extreme age or total body hypothermia are add-on codes, not modifiers, which is a common distractor.

    Source: AMA CPT Anesthesia Guidelines and Appendix A — physical status modifiers P1–P6Report a problem with this question

16. 16. A health plan requires an examination as a condition of continued benefits and directs the patient to obtain it. Which modifier identifies the service as mandated?

    • A.Modifier 33
    • B.Modifier 32✓ Answer
    • C.Modifier GA
    • D.Modifier 22

    Modifier 32 means the service was mandated by a third-party payer, or by a governmental, legislative, or regulatory requirement, which can affect both coverage and how much liability falls on the patient. Its meaning turns on who required the service, so it does not apply to a second opinion the patient seeks on their own initiative. Modifier 33 identifies a preventive service, and GA concerns an advance beneficiary notice rather than a mandate.

    Source: AMA CPT Appendix A (Modifiers) — modifier 32Report a problem with this question

17. 17. A supplier expects Medicare to deny an item as not reasonable and necessary and has a properly executed advance beneficiary notice signed by the patient on file. Which modifier reports that situation?

    • A.GA✓ Answer
    • B.GY
    • C.GX
    • D.GZ

    GA means a waiver of liability statement — a valid advance beneficiary notice — is on file for a service expected to be denied as not reasonable and necessary, and that notice is what preserves the ability to hold the patient financially responsible. GZ carries the same expectation of denial but signals that no notice was obtained, so the patient may not be billed. GY means the item is statutorily excluded and never a Medicare benefit, and GX reports a voluntary notice issued for a non-covered service. Choosing the wrong one misstates whether the patient was warned and who may legitimately be billed.

    Source: CMS HCPCS Level II — modifiers GA, GX, GY and GZ (advance beneficiary notice)Report a problem with this question

18. 18. Which statement correctly describes the ambulance and anatomic modifier families of HCPCS Level II?

    • A.Ambulance modifiers are numeric and report the mileage traveled
    • B.An ambulance modifier is a two-character combination in which the first character names the origin of the transport and the second names the destination, while anatomic modifiers identify a specific side, digit, eyelid, or coronary vessel✓ Answer
    • C.Anatomic modifiers may be used in place of selecting a code that describes the correct site
    • D.Both are CPT Level I modifiers and are therefore always two digits

    HCPCS Level II modifiers may be two letters or a letter plus a digit, unlike CPT modifiers, which are two digits — that structural difference is why an all-alphabetic modifier is possible. Ambulance modifiers are built by pairing an origin letter with a destination letter, so a single two-character modifier states where the transport began and where it ended. Anatomic modifiers add site specificity, which is often what demonstrates that two services were performed on genuinely different structures; they add detail to a code, they never replace choosing the right code.

    Source: CMS HCPCS Level II — ambulance origin/destination modifiers and anatomic modifiersReport a problem with this question

19. 19. A service is described precisely by one code, but the coder instead selects a different, similar code and appends a modifier so that the claim 'fits' the documentation. Which principle applies?

    • A.Modifier 59 exists for exactly this purpose
    • B.Modifier 22 exists for exactly this purpose
    • C.This is acceptable as long as the modifier explains the difference
    • D.A modifier reports an altered circumstance of a service; it never changes what a code means, so the code that most accurately describes the service must be selected instead✓ Answer

    Modifiers add information about how a service was affected — reduced, discontinued, repeated, distinct, split between providers, performed bilaterally — but the code's own definition is fixed. Using a modifier to stretch an inaccurate code makes the claim state something the record does not support, which is a misrepresentation of the service rather than a coding shortcut. Code selection comes first; the modifier only qualifies the correctly chosen code.

    Source: AMA CPT Appendix A (Modifiers) — purpose and proper use of modifiersReport a problem with this question

20. 20. Which statement best describes HCPCS Level II?

    • A.A set of codes each insurer writes for itself, with no national structure
    • B.A code set used to report the patient's diagnoses and the reason for the encounter
    • C.A national code set maintained by CMS in which each code is one letter followed by four digits, used to report items and services CPT does not describe — supplies, durable medical equipment, orthotics and prosthetics, drugs administered other than by mouth, and ambulance transport✓ Answer
    • D.A five-digit numeric code set maintained by the AMA that describes physician procedures and services

    HCPCS has two levels: Level I is CPT, a five-digit numeric set maintained by the AMA that describes procedures and services, and Level II is the national alphanumeric level maintained by CMS for the products, supplies, and services that fall outside CPT's scope. The letter identifies the category of item and the four digits identify the specific item, which is why a coder can predict roughly where an item lives before opening the book.

    Source: CMS HCPCS Level II coding system — Level I (CPT) and Level II structureReport a problem with this question

21. 21. Which statement about the alphabetic categories of HCPCS Level II is correct?

    • A.Letters are assigned in the order applications are received and carry no meaning
    • B.The letter identifies which insurer will pay the claim
    • C.The letter groups codes by the kind of item or service — such as durable medical equipment, orthotics and prosthetics, or drugs administered other than by mouth — and certain letters are set aside for temporary codes that may later become permanent or be deleted✓ Answer
    • D.Every HCPCS Level II code is permanent; codes are never replaced or deleted

    The alphabetic category tells the coder what kind of item a code describes, which is why the same class of product is always found under a predictable letter. Alongside the permanent national codes, some letter categories are reserved for temporary codes, which exist so CMS and other assigning bodies can respond to new items or program needs between regular updates; a temporary code may later be converted to a permanent code or discontinued when it is no longer needed.

    Source: CMS HCPCS Level II coding system — alphabetic categories, permanent and temporary national codesReport a problem with this question

22. 22. A single-dose vial holds more of an injectable drug than the patient's dose requires, and the HCPCS Level II code descriptor defines one unit as a stated amount of that drug. How are the units of service determined, and how is the remainder handled?

    • A.Only the CPT injection administration code is reported; the drug itself is not separately coded
    • B.Units are calculated by dividing the amount administered by the amount stated in the code descriptor, and the discarded remainder is reported separately with the drug-wastage modifier JW, or JZ attests that nothing was discarded✓ Answer
    • C.One unit is reported for the encounter, regardless of the dose administered
    • D.The full vial is always reported as though all of it had been given to the patient

    HCPCS Level II drug codes are dosage based, so the number of units follows the amount stated in the code descriptor rather than the number of vials opened or injections given; the drug product itself is reported with a HCPCS Level II code because CPT describes only the administration, not the substance. Drug discarded from a single-dose container is reported on a separate line with JW, while JZ attests that no amount was discarded, so the two together keep waste visible on the claim instead of hidden inside the administered units.

    Source: CMS HCPCS Level II coding system — dosage-based drug units and modifiers JW and JZReport a problem with this question

Practice questions based on the ICD-10-CM Official Guidelines for Coding and Reporting, the AMA CPT guidelines, the CMS HCPCS Level II system, and federal healthcare compliance law. CPC is a mark of the AAPC and CPT is a mark of the American Medical Association; this site is not affiliated with or endorsed by either. ICD-10-CM, CPT, and HCPCS Level II are revised every year, so these questions test coding rules and conventions rather than code values — always verify actual code selection against the current code books and your payer's published policy. Nothing here is medical, legal, or billing advice. About the CPC exam →