modifier QK, modifier QS, Modifier QX, Modifier QY, QK modifier, QS modifier, QX Modifier, QY Modifier

Anesthesia Modifier QK, Modifier QS, Modifier QX, Modifier QY & Modifier QZ

This billing guide explains how to modifier QK, modifier QS, Modifier QX, Modifier QY, and Modifier QZ for anesthesia services. Below the official descriptions and billing guidelines.

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  1. Modifier QK
    1. Description
    2. Billing Guidelines
  2. Modifier QS
    1. Description
    2. Billing Guidelines
  3. Modifier QX
    1. Description
    2. Billing Guidelines
  4. Modifier QY
    1. Description
    2. Billing Guidelines
  5. Modifier QZ
    1. Description
    2. Billing Guidelines

1. Modifier QK

Modifier QK is a HCPCS modifier and officially described as: “Medical direction of two, three, or four concurrent anesthesia procedures involving qualified individuals.

1.1 Description

The goal of modifier QK is to bill for an anesthesiologist who provides two to four overlapping procedures.

When a physician performs medical direction of two to four concurrent procedures with anesthesia services by qualified individuals, the physician appends modifier QK.

Examples of qualified individuals include certified registered nurse anesthetists (CRNAs), anesthesiologist assistants (AAs), interns, and residents.

Concurrent means that there is some degree of overlap in the procedures. Depending on payer rules, one minute of overlap may be enough for procedures to be considered concurrent.

1.2 Billing Guidelines

Medical direction can vary per payer. Make sure to check payer rules regarding what qualifies as medical direction.

Modifier QK limits payment to 50% of the amount that would have been allowed if personally performed by an anesthesiologist or non-supervised CRNA.

2. Modifier QS

Modifier QS is a HCPCS modifier and officially described as: “Monitored anesthesia care service.”

2.1 Description

The goal of modifier QS is to be appended to an anesthesia code when services provided by an anesthesia specialist are defined as monitored anesthesia care. This is a combination of a local anesthetic with sedation.

Modifier QS indicates that the anesthesia provider, who may be an anesthesiologist or other qualified individual such as a Certified Registered Nurse Anesthetist, CRNA, or Anesthesiologist Assistant, AA, performs monitored anesthesia care.

MAC involves monitoring the patient’s vital signs while in the operating room, examination prior to anesthesia, the prescription for anesthesia care, and postoperative care.

2.2 Billing Guidelines

Modifier QS does not impact reimbursement. This modifier is informational. Use it in addition to P modifiers for anesthesia codes.

Payment for anesthesia claims for modifier QS is 100% allowable.

Report modifier G8 instead of modifier QS if anesthesia provider provides monitored anesthesia care for deep complex, complicated, or markedly invasive surgical procedure.

Report modifier G9 if anesthesia provider provides monitored anesthesia care for a patient who has history of severe cardiopulmonary condition.

Some payers may pay more for modifier QS as long as reasons for providing MAC are medically necessary and documented in the record.

3. Modifier QX

Modifier QX is a HCPCS modifier and officially described as: “Crna service: with medical direction by a physician.”

3.1 Description

The goal of modifier QX is to bill a service performed by a a certified registered nurse anesthetist (CRNA) under the medical direction of a physician.

When a certified registered nurse anesthetist (CRNA) performs an anesthesia service under the medical direction of a physician, the CRNA appends the QX modifier on the claim.

3.2 Billing Guidelines

The anesthesiologist providing medical direction should use a different modifier, such as modifier QY.

Modifier QX limits payment to 50% of the amount that would have been allowed if personally performed by an anesthesiologist or nonsupervised CRNA.

The CRNA should use modifier QZ instead of modifier QX if a CRNA performs anesthesia services without medical direction.

Check payer rules regarding what qualifies as medical direction for this modifier.

4. Modifier QY

Modifier QY is a HCPCS modifier and officially described as: “Medical direction of one certified registered nurse anesthetist (crna) by an anesthesiologist.”

4.1 Description

The goal of modifier QY is to bill for an anesthesiologist who medically directed a certified registered nurse anesthetist (CRNA).

When an anesthesiologist provides medical direction of one certified registered nurse anesthetist (CRNA) performing an anesthesia service, the anesthesiologist appends modifier QY on the claim.

4.2 Billing Guidelines

Report modifier QX for the CRNA who performs the procedure.

Modifier QY limits payment to the anesthesiologist and CRNA to 50% of the amount that would have been allowed if personally performed by the anesthesiologist.

Bill modifier QK for medical direction of two to four concurrent anesthesia procedures.

5. Modifier QZ

Modifier QZ is a HCPCS modifier and officially described as: “Crna service: without medical direction by a physician.”

5.1 Description

The goal of modifier QZ is to bill a service provided by a certified registered nurse anesthetist (CRNA) that is not medically directed by a physician.

When a certified registered nurse anesthetist (CRNA) performs an anesthesia service without the medical direction of a physician, the CRNA appends modifier QZ on the claim.

5.2 Billing Guidelines

Modifier QZ has no effect on payment and the allowed amount is what would have been allowed if personally performed by an anesthesiologist. Payment for anesthesia claims for modifier QZ is 100% allowable.

If a CRNA performs anesthesia services with medical direction, use modifier QX instead of the QZ modifier.

Check payer policy for rules regarding what qualifies as medical direction.


Go back to the complete list of Anesthesia Modifiers.

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