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%)