HCPCS Level II modifier that may be used with CPT or HCPCS Level II codes indicating lower extremity prosthesis functional level 0—does not have the ability or potential to ambulate or transfer safely with or without assistance and a prosthesis does not enhance the patient’s quality of life or mobility.

HCPCS Level II modifier that may be used with CPT or HCPCS Level II codes indicating lower extremity prosthesis functional level 1—has the ability or potential to use a prosthesis for transfers or ambulation on level surfaces at fixed cadence. Typical of the limited and unlimited household ambulator.

HCPCS Level II modifier that may be used with CPT or HCPCS Level II codes indicating lower extremity prosthesis functional level 2—has the ability or potential for ambulation with the ability to traverse low-level environmental barriers such as curbs, stairs, or uneven surfaces. Typical of the limited community ambulator.

HCPCS Level II modifier that may be used with CPT or HCPCS Level II codes indicating lower extremity prosthesis functional level 3—has the ability or potential for ambulation with variable cadence. Typical of the community ambulator who has the ability to transverse most environmental barriers and may have vocational, therapeutic, or exercise activity that demands prosthetic utilization beyond simple locomotion.

HCPCS Level II modifier that may be used with CPT or HCPCS Level II codes indicating lower extremity prosthesis functional level 4—has the ability or potential for prosthetic ambulation that exceeds the basic ambulation skills, exhibiting high impact, stress, or energy levels, typical of the prosthetic demands of the child, active adult, or athlete.

HCPCS Level II modifier that may be used with CPT or HCPCS Level II codes indicating an add-on option/accessory for a wheelchair.

HCPCS Level II modifier that may be used with CPT or HCPCS Level II codes indicating the Medicare beneficiary requested upgrade for Advance Beneficiary Notice (ABN) and that more than four modifiers are identified on the claim.

HCPCS Level II modifier that may be used with CPT or HCPCS Level II codes indicating replacement of special power wheelchair interface.

HCPCS Level II modifier that may be used with CPT or HCPCS Level II codes indicating that a drug or biological was infused through durable medical equipment (DME).