| HCPCS Modifer | Descriptions |
| D |
Diagnostic or therapeutic site other than 'P' or 'H' when these codes are used as origin codes.
Note: This modifier is to be used for transports to or from an Ambulatory Surgical Center (ASC) or a free-standing psychiatric facility.
|
| E |
Residential, domiciliary, custodial facility (other than an 1819 facility) |
|
G
|
Hospital-based dialysis facility (hospital or hospital-related) |
| GM |
Multiple patients on one ambulance trip |
| H |
Hospital
Note: This modifier must be submitted for a psychiatric facility located at a hospital.
|
| I |
Site of transfer (e.g., airport or helicopter pad) between types of ambulance vehicles |
| J |
Non hospital-based dialysis facility |
| N |
Skilled Nursing Facility (SNF) (1819 Facility) |
| P |
Physician’s office (includes HMO non-hospital facility, clinic, etc.)
Note: For Medicare purposes,
Urgent
Care
Centers, Clinics and freestanding Emergency Rooms are considered physician offices.
|
| QL |
Patient pronounced dead after ambulance called. |
| 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 (includes HMO non-hospital facility, clinic, etc.) |