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%)
- Anesthesia modifiers
- AT: Active treatment
- GA and GY: Medicare non-coverage notification
- GN, GO & GP: Therapy type
- UD and UA: Treated and released or admitted/transferred (Medicaid only)
- XE, XS, XP, XU: Distinct services
- 22: Unusual procedural services
- 25: Significant service separate from E&M service
- 26 and TC: Professional and technical components
- 33: Preventive service
- 50 & 51: Bilateral and multiple procedures
- 52: Reduced services
- 53: Discontinued procedure
- 54 & 55: Surgical care and post-op care
- 56: Pre-operative management only
- 59: Distinct procedural service
- 62: Two surgeons
- 73 & 74: Discontinued outpatient surgery
- 76 & 77: Repeated procedures, same day
- 78: Unplanned return to operating room
- 80, 81, 82: Assistant at surgery