Anesthesia modifiers

Physical status modifiers (PS)

(Priority Health accepts these modifiers, but they do not affect payment)

  • P1: A normal healthy patient
  • P2: A patient with mild systemic disease
  • P3: A patient with severe systemic disease
  • P4:A patient with severe systemic disease that is a constant threat to life
  • P5: A moribund patient who is not expected to survive without the operation
  • P6: A declared brain-dead patient whose organs are removed for donor purposes

Modifiers

  • 22: Unusual Procedure/Service: use the Explanation form
  • 23: Unusual Anesthesia (Usually done under local but requires general)
  • 32: Mandated Services (Related to mandated consult or service)
  • 47: Anesthesia by Surgeon (Attached to the appropriate surgery code)
  • 51: Multiple Procedures
  • 53: Discontinued Procedures
  • 59: Distinct Procedural Service

HCPCS Level II modifiers

When related anesthesia services are billed by a CRNA and an anesthesiologist (for medical direction/oversight), the fee is split and each are reimbursed at 50%.

  • QB: Physician provided service in a rural HPSA
  • QK: Medical direction of two, three or four concurrent anesthesia procedures involving qualified individuals
  • QS: Monitored anesthesia care service (MAC)
  • QX: CRNA service: with medical direction by a physician
  • QY: Medical direction of one CRNA by an anesthesiologist
  • QZ: CRNA service: without medical direction by a physician (CRNA paid at 100%)