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    v1.0.28
    OpenPayerPolicy UpdatesReimbursement/Payment PolicyIowa Medicaid Addendum B code/modifier update | Op…
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    CurrentIowa Department of Health and Human ServicesPolicy N/A

    Iowa Medicaid CY2024 Addendum B — CPT/HCPCS code and modifier listing (excerpt)

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    Lists CPT/HCPCS procedure codes with modifier placeholders for Iowa Medicaid (Addendum B), updated for July 1, 2024; this excerpt supplies code/modifier entries for provider billing but contains no coverage criteria.

    Policy Summary
    PayerIowa Department of Health and Human Services
    PolicyIowa Medicaid CY2024 Addendum B — CPT/HCPCS code and modifier listing (excerpt)
    Policy CodePolicy N/A
    Change TypeInformational update (code listing)
    Effective DateJul 1, 2024
    Last ReviewJul 1, 2024
    Next Review DateN/A
    Key ActionUse the listed CPT/HCPCS codes and the 'Modifier = .' placeholders as the billing reference for Iowa Medicaid submissions effective July 1, 2024.
    SourceLink
    POLICY UPDATE CHANGES

    No material clinical or coverage changes in this revision.

    2024-07-01Effective date
    Part 9–14Document parts (partial)
    120+G‑series codes listed
    hundredsCPT/HCPCS entries shown

    Coverage Criteria / Code Listings

    Modifier mapping

    Procedure-to-modifier entries (no coverage rules provided in this segment).

    ALL of the following

    • Procedures listed with modifier placeholder shown as 'Modifier = .'.
    • No clinical coverage criteria, utilization limits, prior authorization, or billing instructions are provided in this segment; entries map procedure codes to modifier placeholders only.

    Billing code listing

    Reference listing of codes and modifier placeholders.

    ALL of the following

    • G‑series HCPCS codes are listed sequentially with a modifier placeholder 'Modifier = .' for each code.
    Policy Summary
    PayerIowa Department of Health and Human Services
    PolicyIowa Medicaid CY2024 Addendum B — CPT/HCPCS code and modifier listing (excerpt)
    Policy CodePolicy N/A
    Change TypeInformational update (code listing)
    Effective DateJul 1, 2024
    Last ReviewJul 1, 2024
    Next Review DateN/A
    Key ActionUse the listed CPT/HCPCS codes and the 'Modifier = .' placeholders as the billing reference for Iowa Medicaid submissions effective July 1, 2024.
    SourceLink
    On This Page
    Coverage Criteria / Code ListingsCPT / HCPCS Code and Modifier ExamplesProvider Billing and Action NotesDefinitions and Placeholder Conventions
  1. This section is informational — it provides codes and modifier placeholders only and does not state coverage determinations, prior authorization requirements, or clinical criteria.

    2. Billing code list (informational)

    No coverage criteria included in these chunks; content is a raw list of codes with modifier placeholders.

    ALL of the following

    • Entries presented as 'Code, Modifier = .' indicate a modifier field is associated with each listed code; the period (.) is used as a placeholder in this addendum.
    • Document header notes this is Iowa Medicaid Addendum B updated for July 1, 2024; the listing is informational for billing and modifier mapping — it does not include coverage rules within these excerpts.

    CPT / HCPCS Code and Modifier Examples

    Sample codes from Addendum B listingmixed
    0001FCPT/HCPCS code listed with 'Modifier = .' placeholder
    00100CPT/HCPCS code listed with 'Modifier = .' placeholder
    0042TCPT/HCPCS code listed with 'Modifier = .' placeholder
    0308TCPT/HCPCS code listed with 'Modifier = .' placeholder
    0699TCPT/HCPCS code listed with 'Modifier = .' placeholder
    Partial list of CPT/HCPCS codes with modifier assignmentmixed
    0594TProcedure code listed with modifier placeholder
    10004Procedure code listed with modifier placeholder
    17106Procedure code listed with modifier placeholder
    Sample CPT/HCPCS codes from list (partial)CPT
    21499Procedure code listed with modifier placeholder
    21501Procedure code listed with modifier placeholder
    21600Procedure code listed with modifier placeholder
    22850Procedure code listed with modifier placeholder
    28360Procedure code listed with modifier placeholder
    Procedure codes with modifiers (partial)CPT | HCPCS
    multiple (see list)Many CPT/HCPCS procedure codes each followed by 'Modifier = .' placeholder
    Sample codes from the listing (partial)CPT
    3451FListed procedure code or modifier entry as shown
    34701Listed procedure code or modifier entry as shown
    3500FListed procedure code or modifier entry as shown
    37200Listed procedure code or modifier entry as shown
    43200Listed procedure code or modifier entry as shown
    44180Listed procedure code or modifier entry as shown
    Sample of listed CPT codesCPTCovered
    43825Procedure code listed with 'Modifier =.'
    44100Procedure code listed with 'Modifier =.'
    45300Procedure code listed with 'Modifier =.'
    Enumerated CPT/HCPCS codes (partial)CPT
    57110Procedure code listed with 'Modifier = .'
    57111Procedure code listed with 'Modifier = .'
    57120Procedure code listed with 'Modifier = .'
    57400Procedure code listed with 'Modifier = .'
    58550Procedure code listed with 'Modifier = .'
    59000Procedure code listed with 'Modifier = .'
    6005FProcedure code listed with 'Modifier = .'
    61000Procedure code listed with 'Modifier = .'
    64400Procedure code listed with 'Modifier = .'
    67208Procedure code listed with 'Modifier = .'
    1–10 of 11
    1/2
    Listed CPT/HCPCS codes (partial sample from this section)CPT
    68440Procedure code listed with modifier placeholder
    69535Procedure code listed with modifier placeholder
    70450Procedure code listed with modifier placeholder
    72170Procedure code listed with modifier placeholder
    77014Procedure code listed with modifier placeholder
    80375Procedure code listed with modifier placeholder
    81376Procedure code listed with modifier placeholder
    81457Procedure code listed with modifier placeholder
    Sample codes from list (full list continues through chunks 144-163)CPT
    81301
    81302
    81303
    Sample codes from listCPT
    87522Procedure code listed with modifier '.'
    90683Procedure code listed with modifier '.'
    97151Procedure code listed with modifier '.'
    Listed CPT/HCPCS codes and modifiers (partial sample)mixed
    96105CPT/HCPCS code listed with modifier reference
    99202CPT/HCPCS code listed with modifier reference
    A0428HCPCS code listed with modifier reference
    A9274HCPCS code listed with modifier reference
    Selected A-series HCPCS codes (example)HCPCS
    A7023
    A7025
    A7520
    Selected C-series codes (example)HCPCS
    C1052
    C1600
    C7520
    Selected Dental D-codes (example)CPT
    D0120
    D1110
    D6080
    Representative codes from D-, E-, and G- series in excerptCPT
    D6050
    D6113
    D6722
    D7856
    D7999
    E0100
    E0350
    E1399
    G0008
    G0175
    1–10 of 11
    1/2
    G‑series HCPCS codes (range examples shown)HCPCS
    G0018Listed with modifier placeholder
    G9784Listed with modifier placeholder
    Selected sample codes from listingmixed
    G9630G-code listed with modifier placeholder
    G9713G-code listed with modifier placeholder
    J0120J-code listed with modifier placeholder
    J7665J-code listed with modifier placeholder
    inv-26: Update effective date
    Effective dateUpdated for July 1, 2024
    Document titleIowa Medicaid Calendar Year (CY) 2024 Addendum B
    ContentsCPT/HCPCS and dental code listings with modifier placeholders
    inv-27: listing completeness
    Scope of segmentPartial sequential listing of CPT/HCPCS procedure codes and modifiers
    Chunk range indicatedThis segment continues across chunks 90–109 (partial)
    Content typeEnumerated codes each followed by 'Modifier = .' placeholder
    inv-28: modifier mapping presence
    Modifier field displayModifier field shown as '.' for listed codes in this section
    ImplicationModifier placeholders accompany each procedure code entry
    Section noteNo specific modifier values provided in this excerpt
    inv-29: modifier placeholder convention
    Placeholder conventionEntries show 'Modifier = .' after each code indicating modifier(s) are documented elsewhere or to be specified when billed
    FormattingThe literal text 'Modifier = .' follows each code in the listing
    Billing guidanceProviders should reference the full addendum or billing instructions for applicable modifier values
    inv-30: completeness
    Listing completenessThis module contains only a partial continuous listing of codes and modifiers; the full list spans multiple parts of Addendum B
    Partial indicatorDocument is divided into multiple parts (this excerpt is one part)
    Provider actionConsult other parts of Addendum B for the complete code/modifier mapping

    Provider Billing and Action Notes

    Billing Rule

    Code listing (Addendum B) — codes paired with 'Modifier = .'

    Addendum B is a code and modifier listing for Iowa Medicaid (updated July 1, 2024); it provides CPT/HCPCS/Dental procedure codes each followed by a modifier placeholder shown as 'Modifier = .' for billing reference. No prior authorization, documentation, denial risk, or step therapy instructions are included in this excerpt.

    • Document title and update: Iowa Medicaid Calendar Year (CY) 2024 Addendum B (Updated for July 1, 2024).
    • Format: Codes enumerated with the pattern 'Code, Modifier = .' (modifier placeholder).
    Billing Rule

    Procedure codes with modifier placeholder (partial listing)

    This segment lists procedure codes (example block) where each code is followed by 'Modifier = .' indicating a modifier placeholder for billing; the list is partial and continues in adjacent sections.

    • Example excerpt: 0594T, Modifier = . 0596T, Modifier = . 0597T, Modifier = . … 0653T, Modifier = .
    • Interpretation: The period (.) is used in the document to show the modifier field for each listed code.
    Billing Rule

    Procedure → Modifier mapping entries (partial)

    Portions of the addendum present procedure-to-modifier mapping lines where each procedure code is followed by 'Modifier = .' to indicate the modifier field applies to that code; these mapping entries are presented as a raw listing without authorization guidance.

    • Sample lines: 21499, Modifier = . 21501, Modifier = . 21502, Modifier = . … 22222, Modifier = .
    • No prior authorization, clinical documentation, or billing rules beyond the modifier placeholder are specified in these lines.
    Billing Rule

    Code/modifier listing (continued partial)

    The document continues enumerating procedure codes with the repeated marker 'Modifier = .' after each code across multiple sequential chunks; these lines function as a code/modifier listing and contain no provider action requirements in this excerpt.

    • Example span: 28092, Modifier = . 28100, Modifier = . 28102, Modifier = . … 28298, Modifier = .
    • This is a continuation of the code/modifier enumeration (partial).
    Billing Rule

    Sequential CPT/HCPCS code lines with modifier placeholders

    Sequential portions of the addendum show numerous CPT/HCPCS procedure codes each followed by 'Modifier = .' as a modifier placeholder; the excerpt is informational and does not include authorization or billing rule instructions beyond the modifier field.

    • Example: 3451F, Modifier = . 34520, Modifier = . 34701, Modifier = . … 35005, Modifier = .
    • Modifier placeholder convention is used consistently in these entries.
    Billing Rule

    CPT procedure code list with modifier field shown

    This section enumerates CPT procedure codes with the label 'Modifier =' after each code; entries show the modifier field as a period (.) indicating a placeholder for modifier values when billed.

    • Sample entries: 43825, Modifier = . 44100, Modifier = . 45300, Modifier = .
    • The segment is a code list (modifiers indicated) and does not specify additional billing actions in this excerpt.
    Billing Rule

    Procedure code list with modifier field (partial)

    The addendum lists procedure codes with a modifier field displayed as a period (.) after each code; this indicates the modifier placeholder convention is applied across many CPT/HCPCS entries in this part of the listing.

    • Examples: 57110, Modifier = . 57111, Modifier = . 57120, Modifier = . … 57510, Modifier = .
    • No clinical or prior authorization instructions are present in these lines.
    Billing Rule

    Procedure codes with modifier placeholders (partial)

    Numerous procedure codes in this excerpt are shown with the markup 'Modifier = .' following each code, indicating that a modifier field applies to each listed code; these entries are presented as a raw billing-code listing.

    • Sample: 68440, Modifier = . 68500, Modifier = . 68700, Modifier = . … 69535, Modifier = .
    • This is a partial excerpt of a larger sequential listing.
    Billing Rule

    Procedure code list (modifiers indicated) — continued

    This excerpt lists many CPT/HCPCS procedure codes each followed by 'Modifier = .' to indicate the modifier placeholder for billing; the listing is extensive and continues across document parts.

    • Examples from this chunk: 81301, Modifier = . 81302, Modifier = . 81303, Modifier = . … 81364, Modifier = .
    • The pattern indicates consistent use of a modifier placeholder across the addendum.
    Billing Rule

    Procedure code — modifier listing (partial sample)

    Procedure codes in this portion are listed with 'Modifier = .' after each code, demonstrating the document's convention of showing a modifier placeholder for these CPT/HCPCS entries.

    • Sample entries: 87522, Modifier = . 90683, Modifier = . 97151, Modifier = .
    • No coverage or prior-authorization rules accompany these lines in this excerpt.
    Billing Rule

    Code list (partial) — codes paired with modifier placeholders

    This chunk contains an enumerated list of CPT/HCPCS codes and the repeated 'Modifier = .' marker after each code; the excerpt is a raw code/modifier listing with no provider action requirements included here.

    • Examples: 96040, Modifier = . 96105, Modifier = . 96202, Modifier = . 96360, Modifier = .
    • The listing is part of a multi-part addendum and is informational in nature.
    Billing Rule

    A‑series HCPCS codes with modifier placeholders (partial)

    A-series HCPCS (Axxxx) codes are listed with 'Modifier = .' entries indicating a modifier placeholder assigned to each A-series code for billing reference; the lines are part of the sequential addendum listing.

    • Examples: A7023, Modifier = . A7025, Modifier = . A7520, Modifier = . A9274, Modifier = .
    • These lines do not include authorization, documentation, or step-therapy instructions in this excerpt.
    Billing Rule

    C‑series HCPCS codes with modifier placeholders (partial)

    C-series HCPCS (Cxxxx) codes are shown with 'Modifier = .' after each code, indicating the modifier placeholder applies to these C-series codes in the addendum listing.

    • Examples: C1062, Modifier = . C1600, Modifier = . C1779, Modifier = . C1780, Modifier = .
    • This is a sequential code/modifier entry without additional billing or prior-authorization detail in this excerpt.
    Billing Rule

    Dental (D‑series) procedure codes with modifier placeholders

    Dental D-codes are enumerated with the modifier placeholder 'Modifier = .' following each code, indicating where a modifier value would be applied for dental procedure billing.

    • Examples: D0120, Modifier = . D1110, Modifier = . D6080, Modifier = . D0707, Modifier = .
    • The excerpt provides the D-code listing only; no dental-specific documentation or authorization rules are present here.
    Billing Rule

    Code list excerpt — modifier placeholder entries

    This excerpt is a code-listing portion showing procedure codes each followed by 'Modifier = .' and contains no provider action instructions; it should be used as a billing reference for code/modifier placement.

    • Sample block: D6050, Modifier = . D6051, Modifier = . D6060, Modifier = . D6113, Modifier = .
    • No additional provider actions (PA, denials, documentation rules) are specified in this chunk.
    Billing Rule

    G‑series HCPCS codes listed with modifier placeholders

    G‑series HCPCS codes (G0018 through Gxxxx ranges) are enumerated with the modifier placeholder 'Modifier = .' indicating the modifier field applies to each G-code; the listing is extensive and presented for billing reference.

    • Examples: G0018, Modifier = . G0019, Modifier = . G9630, Modifier = . G9713, Modifier = .
    • No modifier values are specified in these excerpts; the '.' indicates a placeholder for modifier(s).
    Billing Rule

    Code/modifier listing (billing reference) — mixed series

    The addendum provides a broad code/modifier list including G-codes, CPT/HCPCS and J-codes each followed by 'Modifier = .' for billing reference; this section does not include prior authorization, documentation, denial risk, or step-therapy instructions in the provided excerpt.

    • Sample entries: G9630, Modifier = . G9642, Modifier = . J0120, Modifier = . J7665, Modifier = .
    • Use this listing as a billing reference for code-to-modifier placement; modifier values are not specified here.

    Definitions and Placeholder Conventions

    inv-48: Refers to the CPT/HCPCS code and modifier listing for Iowa Medicaid for CY2024 (updated July 1, 2024) — Addendum B.
    Addendum referenceCPT/HCPCS code and modifier listing for Iowa Medicaid, CY2024 (Addendum B)
    UpdatedDocument header shows update effective July 1, 2024
    IncludesCPT and dental (D) codes with modifier placeholders
    inv-49: Modifier = .
    Modifier placeholderModifier = .
    UsageAppears after each listed procedure code in this excerpt
    InterpretationRepresents an unspecified modifier field in the addendum listing
    inv-50: modifier placeholder indicating an associated modifier mapping entry or that a modifier field applies to the code — 'Modifier = .'
    Placeholder meaning'Modifier = .' indicates an associated modifier mapping entry or that a modifier field applies to the code
    PresentationThe period (.) is used as the placeholder value in the modifier field
    ActionRefer to the complete addendum or payer instructions for the actual modifier to submit
    inv-51: Modifier list (partial)
    Block typeRaw enumeration of procedure codes with modifier placeholders (partial)
    PurposePart of the reimbursement addendum code/modifier listing
    CompletenessThis is a partial list; full enumeration appears elsewhere in Addendum B
    inv-52: Code/modifier list (partial)
    FormatProcedure codes enumerated and followed by the phrase 'Modifier = .' indicating modifier placeholders
    ScopeThis part of the document lists specific procedure codes each with a modifier placeholder
    Provider noteNo coverage criteria or modifier values are specified in this excerpt
    inv-53: Modifier
    Modifier tokenModifier =
    Displayed formUsed consistently before the placeholder period in each code entry
    ContextAppears throughout the CPT/HCPCS listings in Addendum B
    inv-54: Modifier field — ''Modifier = .': the document presents a modifier field for each procedure code, shown as a period (.) in this section.'
    Modifier field presentation'Modifier = .': the document presents a modifier field for each procedure code, shown as a period (.) in this section
    ImplicationThe field is present but no explicit modifier value is provided in these chunks
    Action for providersConfirm applicable modifier values in the complete addendum or payer guidance before billing
    inv-55: Modifier = .
    Repeated placeholderModifier = .
    PositioningShown after each procedure code entry throughout the excerpt
    NoteServes as a placeholder indicating modifier assignment exists in the addendum structure
    inv-56: Modifier placeholder — ''Modifier = .' appears repeatedly after each code indicating where modifier values are to be applied in billing submissions.'
    Modifier placeholder use'Modifier = .' appears repeatedly after each code indicating where modifier values are to be applied in billing submissions
    Listing behaviorModifier placeholder is consistently applied across code ranges (e.g., 81301–81364) in this excerpt
    Provider guidanceRefer to full addendum or payer resources for specific modifier assignments
    inv-57: Modifier = .
    Displayed valueModifier = . (period) indicates the modifier field for the listed codes in this section
    ApplicationUsed for a wide range of CPT codes in the specimen/testing code blocks (e.g., 87522, 90683)
    DocumentationNo additional modifier mapping information is provided in this excerpt
    inv-58: Code list (partial)
    List typeEnumerated listing of procedure codes with the phrase 'Modifier =' repeated
    Excerpt natureThis chunk is a partial code list showing codes and associated modifier placeholders
    No coverage rulesThe excerpt contains no prior authorization or coverage decision language
    inv-59: Modifier placeholder entry
    Entry formatProcedure codes listed followed by 'Modifier = .', indicating where modifier values are specified in the full addendum
    Example seriesA-series HCPCS codes shown with placeholder modifiers in this excerpt
    CompletenessPartial listing; consult full Addendum B for complete modifier mappings
    inv-60: Modifier = .
    Placeholder indicationModifier = . is used as the placeholder for each listed dental procedure code in this excerpt
    Series shownDental D-codes (e.g., D6050–D6113) are presented with modifier placeholders
    Provider noteActual modifier values are not specified here and must be obtained from the full addendum or payer guidance
    inv-61: Modifier = .
    Placeholder meaning'Modifier = .': placeholder indicating the modifier value is not specified in this listing
    Series exampleG-series HCPCS codes (G0018–G0083 shown) use the same placeholder convention
    ActionReview other parts of the addendum for modifier specifics before claim submission
    inv-62: Modifier listing format
    Listing formatEntries are presented as 'Code, Modifier = .' indicating codes and an associated modifier field or placeholder
    ScopeApplies across CPT, HCPCS (A/C/G series), D (dental), and J (drug) codes in the addendum excerpts
    Provider guidanceThe placeholder signals that modifier specification is part of the addendum structure; confirm exact modifiers in the complete document