In simple words: Modifier TR is used when a healthcare provider gives personalized school-based special education services to a student outside of their assigned public school district.

Use HCPCS modifier TR when the provider renders a personalized school-based education program for a student outside the public school district responsible for the student. A comprehensive IEP treatment plan developed for a specific child may include behavior health, physical therapy, occupational therapy, speech therapy, and audiology services, along with screening and assessment services, and even IEP specialized transportation.

Example 1: A child with autism receives speech therapy and occupational therapy services at a private clinic as part of their IEP, because the services are not available within their public school district. Modifier TR is appended to the HCPCS codes for these therapies., A student with a physical disability requires specialized transportation to and from a private physical therapy center for IEP-mandated sessions not offered by their school district. The transportation provider uses modifier TR along with the appropriate transportation HCPCS code., A child with a learning disability receives specialized tutoring and behavioral therapy at a private learning center, as outlined in their IEP, because their public school cannot accommodate these needs. Modifier TR is used with the codes for these services.

Documentation should clearly demonstrate that the services provided are part of the student's IEP, are medically necessary, and are furnished outside the responsible public school district. Records must specify the services provided, the provider's qualifications, and the rationale for providing the services outside the school system.

** Medicare does not cover services billed with modifier TR. This modifier is used for reporting purposes to indicate that the IEP services were provided outside the responsible public school system.