ANESTHESIA MODIFIERS LIST

Anesthesia Modifiers

 What is a modifier and what’s the purpose of its use?

A modifier is a two-position alpha or numeric code appended to a CPT code to clarify the services being billed. Modifiers provide a means by which a service can be altered without changing the procedure code.

They add more information, such as the anatomical site, to the code. In additional, they help to eliminate the appearance of duplicate billing and unbundling. Modifiers are used to increase accuracy in reimbursement, coding consistency, editing, and to capture payment data.

Modifiers for anesthesia pricing shall be placed correctly on claims submitted to National Government Services, Inc. Claims submitted incorrectly will suspend and require manual intervention, thus causing delays in claims processing and potential of processing errors.

In anesthesia every anesthesia procedure billed to Medicare must include one of the following anesthesia HCPCS modifiers:

Anesthesia Pricing Modifiers

The anesthesia pricing modifiers shall be listed in first position to ensure correct reimbursement.

AA: Anesthesia services personally performed by an anesthesiologist.

This modifier allows full fee schedule reimbursement.

AD: Medical supervision by an anesthesiologist: more than 4 concurrent anesthesia procedures

QK: Medical direction of 2, 3, or 4 concurrent anesthesia procedures involving qualified individuals

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

QX: CRNA service with medical direction by an anesthesiologist

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

QY: Anesthesiologist medically directs one CRNA

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

QZ: CRNA service without medical direction by an anesthesiologist

This modifier has no effect on payment and the allowed amount is what would have been allowed if personally performed by an anesthesiologist.


33: Preventive Services: When the primary purpose of the service is the delivery of an evidence based service in accordance with a USPSTF A or B rating in effect and other preventive services identified in preventive services mandates (legislative or regulatory). This modifier is appended to anesthesia CPT code 00810, which will waive the Medicare deductible and coinsurance

PT: A colorectal cancer screening test which led to a diagnostic procedure. This modifier is appended to anesthesia CPT code 00810, which will waive the Medicare deductible.


Anesthesia Informational Modifiers


Anesthesia informational modifiers that shall be placed in the second modifier position.

QS: Monitored anesthesia care (MAC)

G8: MAC for deep complex complicated or markedly invasive surgical procedures and may be used in lieu of modifier QS.

G9: MAC for a patient who has a history of severe cardiopulmonary condition and may be used in lieu of modifier QS.

GC: Performed by a resident under the direction of a teaching physician: provider must also use one of the other pricing modifiers in the first modifier position

Note: Medicare does not recognize Physical Status P modifiers. If using these modifiers, append as the very last modifier.

These modifiers are informational only and do not affect payment.


Payment fore Anesthesia claims on Modifiers

AA = 100% of allowable

AD = 100% of allowable

QS = 100% of allowable

QZ = 100% of allowable

QK = 50% of allowable

QX = 50% of allowable

QY = 50% of allowable

P3 = 1 additional time unit

P4 = 2 additional time units

P5 = 3 additional time units

Surgical Anesthesia Modifiers

Procedure codes in the Anesthesia section of the Current Procedural Terminology manual are to be used to bill for surgical anesthesia procedures.

• Reimbursement for surgical anesthesia procedures will be based on formulas utilizing base units, time units (1= 15 min) and a conversion factor.

• Reimbursement for moderate sedation and maternity-related procedures, other than general anesthesia for vaginal delivery, will be a flat fee.

• Minutes must be reported on all anesthesia claims except where policy states otherwise. The following modifiers are to be used to bill for surgical anesthesia services:

Modifier Servicing Provider Surgical Anesthesia Service

AA Anesthesiologist Anesthesia services performed personally by the anesthesiologist

QY Anesthesiologist Medical direction* of one CRNA

QK Anesthesiologist Medical direction of two, three, or four concurrent anesthesia procedures involving qualified individuals

QX CRNA CRNA service with direction by an anesthesiologist

QZ CRNA CRNA service without medical direction by an anesthesiologist

The following is an explanation of billable modifier combinations:

• Modifiers which can stand alone: AA and QZ.

• Modifiers which need a partner: QK, QX and QY.

• Legitimate combinations: QK and QX QY and QX


Does it matter what position modifiers are submitted on an anesthesia claim?

Answer:

Yes. Documentation modifiers must be submitted in the first position. The appropriate modifier from the list below must be submitted in the first position to indicate whether the service was personally performed, medically directed, or medically supervised:

AA – Anesthesia services performed personally by an anesthesiologist.

QK - Medical direction by a physician of two, three, or four concurrent anesthesia procedures.

AD - Medically supervised by a physician, more than four concurrent anesthesia procedures.

QY - Medical direction of one CRNA/AA (Anesthesiologist's Assistant) by an anesthesiologist.

QX - CRNA/AA (Anesthesiologist's Assistant) service with medical direction by a physician.

QZ - CRNA/AA (Anesthesiologist's Assistant) service without medical direction by a physician.

If one of the following monitored anesthesia modifiers applies, it must be submitted as an additional modifier in the second position:

QS - Monitored anesthesia care service

G8 - Monitored anesthesia care (MAC) for deep complex complicated, or markedly invasive surgical procedures

G9 - Monitored anesthesia care for patient who has a history of severe cardio-pulmonary condition

Processing delays and rejections may occur for claims submitted without the modifiers in the correct position.



Modifier Information Billed by an Anesthesiologist : 

AA Anesthesia services personally performed by the anesthesiologist
AD Supervision, more than four procedures
QK Medical Direction of two, three or four concurrent anesthesia procedures
QY Medical Direction of one CRNA by an anesthesiologist


Modifier Information Billed by a CRNA :

QX Anesthesia, CRNA medically directed
QZ Anesthesia,  CRNA  not  medically directed


Anesthesia Modifier Reimbursement

The HMO Blue Texas and Blue Cross and Blue Shield of Texas maximum allowable fees for services billed as MD supervision of a CRNA are as follows:

QY MD Medical Direction of a CRNA $325.52
QK MD Medical Direction of a CRNA $310.01
AD MD supervision of a CRNA $162.76


OB Time and Points Maximum Allowable Points

The following are the current HMO Blue Texas and Blue Cross and Blue Shield of Texas total maximum allowable points for Vaginal or Cesarean deliveries:

Obstetrical Vaginal delivery: 23 total maximum allowable points
Obstetrical Cesarean delivery: 32 total maximum allowable points

If general anesthesia is used in the performance of any obstetrical Vaginal or Cesarean delivery, the maximum allowable points are applicable. In the event that total actual points are less than the total maximum allowable points, you will be reimbursed based on total actual points.

Effective July 1, 2014, 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.

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