| Modifier 78 | G-13001 · Effective Sep 11, 2025 · Medicaid · TX | — | Original policy ↗ |
| Modifier 78 | G-06016 · Effective Nov 16, 2018 · Medicaid · TX | — | Original policy ↗ |
| Modifier 78 Unplanned Return to the Operating Procedure Room | G-13001 · Effective Sep 11, 2025 · Medicaid · WV | — | Original policy ↗ |
| Modifier 90 | G-20001 · Effective Jul 21, 2025 · Medicaid · DC | — | Original policy ↗ |
| Modifier 90 | G-20001 · Effective Jul 21, 2025 · Medicaid · WV | — | Original policy ↗ |
| Modifier 90: Reference (Outside) Laboratory and Pass-Through Billing | G-20001 · Effective Oct 1, 2021 · Medicaid · TX | — | Original policy ↗ |
| Modifier 91 | G-06020 · Effective Jul 17, 2024 · Medicaid · DC | — | Original policy ↗ |
| Modifier 91 | G-06020 · Effective Jul 17, 2024 · Medicaid · TX | — | Original policy ↗ |
| Modifier 91 | G-06020 · Effective Jul 17, 2024 · Medicaid · WV | — | Original policy ↗ |
| Modifier 91 | G-06020 · Effective Jul 1, 2017 · Medicaid · WV | — | Original policy ↗ |
| Modifier LT and RT Left Side Right Side Procedures | G-07022 · Effective Jul 21, 2025 · Medicaid · WV | — | Original policy ↗ |
| Modifier Usage | G-06006 · Effective Jan 16, 2024 · Medicaid · DC | — | Original policy ↗ |
| Modifier Usage | G-06006 · Effective Jan 16, 2024 · Medicaid · MD | — | Original policy ↗ |
| Modifier Usage | G-06006 · Effective Jan 16, 2024 · AZ, IA, NJ, SC, TN, TX, WA | — | Original policy ↗ |
| Modifier Usage | G-06006 · Effective Jan 16, 2024 · Medicaid · TX | — | Original policy ↗ |
| Modifier Usage | G-06006 · Effective Jan 16, 2024 · Medicaid · TX | — | Original policy ↗ |
| Modifier Usage | G-06006 · Effective Jan 16, 2024 · Medicaid · WV | — | Original policy ↗ |
| Modifiers 25 and 57 | G-06003 · Effective Apr 1, 2023 · Medicaid · WV | 1 | Original policy ↗ |
| Modifiers 25 and 57: Evaluation and Management with Global Procedures | G-06003 · Effective May 22, 2024 · Medicaid · DC | 1 | Original policy ↗ |
| Modifiers 25 and 57: Evaluation and Management with Global Procedures | G-06003 · Effective May 22, 2024 · Medicaid · MD | 1 | Original policy ↗ |
| Modifiers 25 and 57: Evaluation and Management with Global Procedures | G-06003 · Effective Apr 1, 2026 · AZ, IA, NJ, NM, SC, TN, TX, WA, WV | 1 | Original policy ↗ |
| Modifiers 25 and 57: Evaluation and Management with Global Procedures | G-06003 · Effective Apr 27, 2022 · Medicaid · TX | — | Original policy ↗ |
| Modifiers 25 and 57: Evaluation and Management with Global Procedures | G-06003 · Effective May 22, 2024 · Medicaid · TX | — | Original policy ↗ |
| Modifiers 25 and 57: Evaluation and Management with Global Procedures | G-06003 · Effective May 22, 2024 · Medicaid · WV | 1 | Original policy ↗ |
| Modifiers 26 and TC | G-15004 · Effective Oct 30, 2023 · Medicaid · DC | — | Original policy ↗ |
| Modifiers 26 and TC | G-14005 · Effective Oct 30, 2023 · Medicaid · MD | — | Original policy ↗ |
| Modifiers 26 and TC | G-15004 · Effective Oct 30, 2023 · AZ, IA, NJ, SC, TN, TX, WA | — | Original policy ↗ |
| Modifiers 26 and TC | G-15004 · Effective Oct 30, 2023 · Medicaid · TX | — | Original policy ↗ |
| Modifiers 26 and TC | G-15004 · Effective Oct 30, 2023 · Medicaid · TX | — | Original policy ↗ |
| Modifiers 50 and 51: Multiple and Bilateral Surgery | G-06010 · Effective Dec 18, 2025 · Medicaid · DC | — | Original policy ↗ |
| Modifiers 50 and 51: Multiple and Bilateral Surgery | G-06010 · Effective Dec 18, 2025 · Medicaid · MD | — | Original policy ↗ |
| Modifiers 50 and 51: Multiple and Bilateral Surgery | G-06010 · Effective Dec 18, 2025 · SC, TX | — | Original policy ↗ |
| Modifiers 50 and 51: Multiple and Bilateral Surgery | G-06010 · Effective Dec 18, 2025 · Medicaid · TX | — | Original policy ↗ |
| Modifiers 50 and 51: Multiple and Bilateral Surgery | G-06010 · Effective Mar 1, 2020 · Medicaid · TX | — | Original policy ↗ |
| Modifiers 52, 53, 73 and 74: Reduced and Discontinued Services | G-10033 · Effective Oct 23, 2025 · Medicaid · DC | — | Original policy ↗ |
| Modifiers 52, 53, 73 and 74: Reduced and Discontinued Services | G-10033 · Effective Oct 23, 2025 · Medicaid · MD | — | Original policy ↗ |
| Modifiers 52, 53, 73 and 74: Reduced and Discontinued Services | G-10033 · Effective Oct 23, 2025 · IA, SC, WA | — | Original policy ↗ |
| Modifiers 52, 53, 73 and 74: Reduced and Discontinued Services | G-10033 · Effective Oct 23, 2025 · Medicaid · TX | — | Original policy ↗ |
| Modifiers 52, 53, 73 and 74: Reduced and Discontinued Services | G-10033 · Effective Oct 23, 2025 · Medicaid · WV | — | Original policy ↗ |
| Modifiers 52, 53, 73, and 74: Reduced and Discontinued Services | G-10033 · Effective Dec 14, 2023 · Medicaid · TX | — | Original policy ↗ |
| Modifiers 59, XE, XP, XS, XU: Distinct Procedural Service | G-15001 · Effective Apr 12, 2022 · AZ, IA, NJ, SC, TN, TX, WA | — | Original policy ↗ |
| Modifiers 59, XE, XP, XS, XU: Distinct Procedural Services | G-15001 · Effective Apr 1, 2023 · Medicaid · DC | — | Original policy ↗ |
| Modifiers 59, XE, XP, XS, XU: Distinct Procedural Services | G-15001 · Effective Apr 12, 2022 · Medicaid · MD | — | Original policy ↗ |
| Modifiers 59, XE, XP, XS, XU: Distinct Procedural Services | G-15001 · Effective Apr 11, 2022 · Medicaid · TX | — | Original policy ↗ |
| Modifiers 59, XE, XP, XS, XU: Distinct Procedural Services | G-15001 · Effective Apr 12, 2022 · Medicaid · TX | — | Original policy ↗ |
| Modifiers 59, XE, XP, XS, XU: Distinct Procedural Services | G-15001 · Effective May 22, 2024 · Medicaid · WV | — | Original policy ↗ |
| Modifiers 80, 81, 82 and AS: Assistant at Surgery | G-06005 · Effective Dec 18, 2025 · Medicaid · DC | — | Original policy ↗ |
| Modifiers 80, 81, 82 and AS: Assistant at Surgery | G-06005 · Effective Dec 18, 2025 · Medicaid · GA, MD, TN, WA | — | Original policy ↗ |
| Modifiers 80, 81, 82 and AS: Assistant at Surgery | G-06005 · Effective Dec 18, 2025 · AZ, IA, NJ, SC, TN, TX, WA | — | Original policy ↗ |
| Modifiers 80, 81, 82 and AS: Assistant at Surgery | G-06005 · Effective Dec 18, 2025 · Medicaid · TX | — | Original policy ↗ |
