Allowable modifiers for DMS are listed in the following tables.
| Modifier | Description |
|---|---|
| 22 | Unusual procedural services |
| 59 | Distinct procedural service |
| KS | Glucose monitor supply for diabetic beneficiary not treated with insulin |
| KX | Specific required documentation on file [glucose monitor supply for diabetic beneficiary treated with insulin] |
| RR | Rental |
| SC* | Medically necessary service or supply |
*Required for PA requests only.
The following table lists allowable modifiers that may be used with procedure code T1999 (Miscellaneous therapeutic items and supplies, retail purchases, not otherwise classified) for IV supplies.
| Supply | Procedure Code | Modifier |
|---|---|---|
| Biohazard disposable container, needle and syringe-1 gallon/medium | T1999 | U1 |
| Biohazard disposable container, needle and syringe-2 gallon/large | T1999 | U2 |
| IV universal secure device | T1999 | U3 |
| Multi Use, IV Cap, Male/Female Luer Lock | T1999 | U4 |
| IV Administration cassette, includes 50 and 100 cc and tubing | T1999 | U5 |
| Central line dressing change kit | T1999 | U6 |
| IV Pump Administration Set | T1999 | U7 |
| IV Valve Connector | T1999 | U8 |
| IV catheter/infusion set | T1999 | U9 |