Item provided without cost to provider, supplier or practitioner, or full credit received for replaced device (including: covered under warranty, replaced due to defect and free samples).


  • This modifier is intended for use with procedures or devices submitted by ambulatory surgical centers (ASCs)
  • Report this modifier with the facility charge for the surgery when a device is furnished at no cost or furnished with a full credit for a replacement device
  • This modifier may be reported with the CPT/HCPCS codes listed on the ASC FB/FC Device Adjustment Policy files on the CMS website 

Contact Palmetto GBA JJ Part B Medicare

Provider Contact Center: 877-567-7271

Email JJ Part B

Contact a specific JJ Part B department

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