Anesthesia modifiers can be used to clarify a CPT code for a service that is billed. The modifiers can be used to alter a service without having to change a CPT code. This article covers all the modifiers that can be used for anesthesia services.
Click on a link to jump to the section of this article.
- What Are Anesthesia Modifiers?
- How To Bill Anesthesia Modifiers
- Position Of Modifiers On Anesthesia Claims
- Anesthesia Pricing Modifiers
- Anesthesia Physical Status Modifiers
- Anesthesia Informational Modifiers
1. What Are Anesthesia Modifiers?
Anesthesia modifiers also add information to a code and eliminate or prevent unbundling or duplicate billing. They increase code consistency, editing, reimbursement accuracy, and capturing data.
Make sure to submit the anesthesia modifiers correctly on claims that are committed to the national government services. Incorrect claims will need manual intervention and cause delays.
Modifier QS, Modifier G8 and Modifier G9 are informational only and do not affect payment. Informational modifiers must be used in the second modifier position, in conjunction with a pricing anesthesia modifier in the first modifier position.
2. How To Bill Anesthesia Modifiers
Anesthesia procedures are billed with the CPT codes that can be found in the manual in the Anesthesia section.
Reimbursement for surgical anesthesia services is calculated based on a conversion factor, time units of 15 minutes, and base units.
A flat fee is used for reimbursement for maternity-related procedures and moderate sedation. General anesthesia for vaginal delivery is an exception.
Report minutes on anesthesia claims. Only leave it out if the policy states otherwise.
Bill surgical anesthesia services with the following anesthesia modifiers:
- Modifier QZ: CRNA service without medical direction by an anesthesiologist.
- Modifier QX: CRNA service with direction by an anesthesiologist.
- Modifier QK: Anesthesiologist Medical direction of two, three, or four concurrent anesthesia procedures involving qualified individuals.
- Modifier QY: Anesthesiologist Medical direction of one CRNA.
- Modifier AA: Anesthesiologist Anesthesia services performed personally by the anesthesiologist.
The following is an explanation of billable modifier combinations:
- Legitimate modifier combinations: Modifier QK and QX QY and Modifier QX
- Modifiers that need a partner: Modifier QK, Modifier QX, and Modifier QY.
- Modifiers that can stand alone: Modifier AA and Modifier QZ.
3. Position Of Modifiers On Anesthesia Claims
Document anesthesia modifier in the first position to indicate whether the service was medically directed, medically supervised, or personally performed.
Claims submitted without anesthesia modifiers in the correct position can result in rejections or processing delays.
Below are the maximum allowable fees for anesthesia services billed as MD supervision of a CRNA for Blue Cross and Blue Shield of Texas and HMO Blue Texas.
- Modifier QY reimbursement: $325.52 (MD Medical Direction of a CRNA).
- Modifier AD reimbursement: $162.76 (MD supervision of a CRNA).
- Modifier QK reimbursement: $310.01 (MD Medical Direction of a CRNA).
Anesthesia modifiers billed to Medicare must include at least one of the modifiers below.
5. Anesthesia Pricing Modifiers
An anesthesia pricing modifier has to be listed in the first position in order to receive reimbursement.
5.1 Modifier AA
AA Modifier description: Anesthesia services are personally performed by an anesthesiologist.
Payment for modifier AA for anesthesia claims is 100% allowable. This modifier allows full fee schedule reimbursement.
5.2 Modifier AD
AD Modifier description: Medical direction of 2, 3, or 4 concurrent anesthesia procedures involving qualified individuals.
Modifier AD limits payment to 50% of the amount that would have been allowed if personally performed by an anesthesiologist or nonsupervised CRNA.
5.3 Modifier QK
QK Modifier description: Medical direction of two, three, or four concurrent anesthesia procedures involving qualified individuals.
Read more about Modifier QK in this billing guide.
5.4 Modifier QS
QS Modifier description: Monitored anesthesia care service.
Read more about Modifier QS in this billing guide.
5.5 Modifier QX
QX Modifier description: CRNA service with medical direction by an anesthesiologist.
Read more about Modifier QX in this billing guide.
5.6 Modifier QY
QY Modifier description: Anesthesiologist medically directs one CRNA.
Read more about Modifier QY in this billing guide.
5.7 Modifier QZ
QZ Modifier description: CRNA service without medical direction by an anesthesiologist.
Read more about Modifier QZ in this billing guide.
5.8 Modifier 33
33 Modifier description: Preventive Services.
Medicare deductible and coinsurance will be waived if modifier 33 is appended to CPT 00810 for anesthesia services.
5.9 Modifier PT
PT Modifier description: A colorectal cancer screening test that led to a diagnostic procedure. This modifier is appended to anesthesia CPT code 00810 and will waive the Medicare deductible.
6. Anesthesia Physical Status Modifiers
If physical status modifiers P3, P4, or P5 are billed, the full unit value for these physical status modifiers will be reimbursed even if the obstetrical delivery total maximum allowable points have been met.
6.1 Modifier P1
P1 Modifier description: A normal healthy patient.
6.2 Modifier P2
P2 Modifier description: A patient with mild systemic disease.
6.3 Modifier P3
P3 Modifier description: A patient with severe systemic disease.
One additional time unit is allowed.
6.4 Modifier P4
P4 Modifier description: A patient with severe systemic disease that is a constant threat to life.
Two additional time units are allowed.
6.5 Modifier P5
P5 Modifier description: A moribund patient who is not expected to survive without the operation.
Three additional time units are allowed.
6.6 Modifier P6
P6 Modifier description: A declared brain-dead patient whose organs are being removed for donor purposes.
7. Anesthesia Informational Modifiers
Anesthesia informational modifiers shall be placed in the second modifier position.
7.1 Modifier QS
QS Modifier description: Monitored anesthesia care (MAC).
7.2 Modifier G8
G8 Modifier description: MAC for deep complex complicated or markedly invasive surgical procedures and may be used in lieu of modifier QS.
7.3 Modifier G9
G9 Modifier description: MAC for a patient who has a history of severe cardiopulmonary condition and may be used in lieu of modifier QS.
7.4 Modifier GC
GC Modifier description: Performed by a resident under the direction of a teaching physician: the provider must also use one of the other pricing modifiers in the first modifier position.