CG Modifier
Policy criteria applied
HCPCS modifierCG
- Description
- Policy criteria applied
- Short description
- Policy criteria applied
- Added
- July 1, 2008
- Last change
- July 1, 2008
What does the CG modifier mean?
The HCPCS Level II modifier CG means: “Policy criteria applied”. Append it to a HCPCS or CPT code on the claim line when the payer’s policy calls for it; placement and payment effects are defined by each payer.
Other C modifiers
- CA – Procedure payable only in the inpatient setting when performed emergently on an outpatient who expires prior to admission
- CB – Service ordered by a renal dialysis facility (rdf) physician as part of the esrd beneficiary's dialysis benefit, is not part of the composite rate, and is separately reimbursable
- CC – Procedure code change (use 'cc' when the procedure code submitted was changed either for administrative reasons or because an incorrect code was filed)
- CD – Amcc test has been ordered by an esrd facility or mcp physician that is part of the composite rate and is not separately billable
- CE – Amcc test has been ordered by an esrd facility or mcp physician that is a composite rate test but is beyond the normal frequency covered under the rate and is separately reimbursable based on medical necessity
- CF – Amcc test has been ordered by an esrd facility or mcp physician that is not part of the composite rate and is separately billable
- CH – 0 percent impaired, limited or restricted
- CI – At least 1 percent but less than 20 percent impaired, limited or restricted
- CJ – At least 20 percent but less than 40 percent impaired, limited or restricted
- CK – At least 40 percent but less than 60 percent impaired, limited or restricted
- CL – At least 60 percent but less than 80 percent impaired, limited or restricted
- CM – At least 80 percent but less than 100 percent impaired, limited or restricted
- CN – 100 percent impaired, limited or restricted
- CO – Outpatient occupational therapy services furnished in whole or in part by an occupational therapy assistant
- CQ – Outpatient physical therapy services furnished in whole or in part by a physical therapist assistant
- CR – Catastrophe/disaster related
- CS – Cost-sharing waived for specified covid-19 testing-related services that result in and order for or administration of a covid-19 test and/or used for cost-sharing waived preventive services furnished via telehealth in rural health clinics and federally qualified health centers during the covid-19 public health emergency
- CT – Computed tomography services furnished using equipment that does not meet each of the attributes of the national electrical manufacturers association (nema) xr-29-2013 standard