HCPCS Code M1226

A modifier provides the means by which the reporting physician or provider can indicate that a service or procedure that has been performed has been altered by some specific circumstance but not changed in its definition or code. Modifiers may be used to indicate to the recipient of a report that:

• A service or procedure has both a professional and technical component.
• A service or procedure was performed by more than one physician and/or in more than one location.
• A service or procedure has been increased or reduced.
• Only part of a service was performed.
• An adjunctive service was performed.
• A bilateral procedure was performed.
• A service or procedure was provided more than once.
• Unusual events occurred.

Code used to identify the appropriate methodology for developing unique pricing amounts under part B. A procedure may have one to four pricing codes.

Code used to identify instances where a procedure could be priced under multiple methodologies.

A code denoting Medicare coverage status.

The Berenson-Eggers Type of Service (BETOS) for the procedure code based on generally agreed upon clinically meaningful groupings of procedures and services.

A code denoting the change made to a procedure or modifier code within the HCPCS system.

The date the HCPCS code was added to the Healthcare common procedure coding system.

Effective date of action to a procedure or modifier code

The carrier assigned CMS type of service which describes the particular kind(s) of service represented by the procedure code.

Number identifying statute reference for coverage or noncoverage of procedure or service.