- Anesthesia Billing Guide
- Anesthesia Billing Codes
- Anesthesia Billing Modifiers
- Anesthesia
- Concurrent, Medical Direction and Supervision
- Daily Management and Pain Management
- Group/Member Practice Responsibilities
- Local Coverage Determinations
- Moderate (Conscious) Sedation
- Monitoring Anesthesia Services
- National Coverage Determinations
- Payment and Reimbursement
- Provider Qualifications
- Teaching Anesthesiology Services
- Resources and References
- Related Articles
Anesthesia Billing Modifiers
Table of Contents
Physician Anesthesia Modifiers
Anesthesia modifiers must be used with anesthesia procedure codes to indicate whether the procedure was personally performed, medically directed, or medically supervised.
Do not use the modifiers below if the provider of service is a qualified nonphysician anesthetist, an AA or CRNA.
| Modifiers | Description | Rendering Physician |
|---|---|---|
| AA | Anesthesia service personally performed by the anesthesiologist | Anesthesiologist/Physician |
| QY | Medical direction of one Qualified Nonphysician Anesthetist by an anesthesiologist, 50% cutback. | Anesthesiologist/Physician |
| QK | Medical direction of two, three or four concurrent anesthesia procedures, 50% cutback. | Anesthesiologist/Physician |
| AD | Supervision, more than four procedures | Anesthesiologist/Physician |
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Qualified Nonphysician Anesthetist Modifiers
An AA may personally administer anesthesia during a surgical procedure or administer anesthesia under the medical direction of anesthesiologist or physician.
Payment to an AA or CRNA may only be made on an assigned basis. Payment for services of the AA or CRNA may be made to the AA or CRNA furnishing the services or to a hospital, rural primary care hospital, physician, group practice or ambulatory surgical center.
Do not use the modifiers below if the provider of service is an anesthesiologist or physician.
| Modifiers | Description | Rendering Physician |
|---|---|---|
| QX | Anesthesia, Qualified Nonphysician Anesthetist medically directed, 50% cutback. | AA and CRNA |
| QZ | Anesthesia, Qualified Nonphysician Anesthetist not medically directed. | AA and CRNA |
Monitored Anesthesia Care (MAC)
| Modifiers | Description | Rendering Physician |
|---|---|---|
| QS | Monitored Anesthesia Care services (can billed by a qualified nonphysician anesthetist, AA or physician) | INFORMATIONAL ONLY |
MAC Deep Complex Complicated
MAC for deep complex complicated or markedly invasive surgical procedures and may be used in lieu of modifier QS.
| Modifiers | Description | Rendering Physician |
|---|---|---|
| G8 | Monitored anesthesia care for deep complex complicated, or markedly invasive surgical procedures ‒ provider must also use the appropriate level of direction anesthesia modifier | Anesthesiologist or physician or other qualified individual under the medical direction of a physician. |
| G9 | Monitored anesthesia care for a patient who has a history of severe cardio-pulmonary condition ‒ provider must also use the appropriate level of direction anesthesia modifier | Anesthesiologist or physician or other qualified individual under the medical direction of a physician. |
Teaching Physicians
| Modifiers | Description | Rendering Physician |
|---|---|---|
| GC | Performed by a resident under the direction of a teaching physician ‒ provider must also use one of the other payment modifiers | Teaching anesthesiologists/physician |
Unusual Anesthesia Modifier
Append modifier 31 to an anesthesia code when the provider administers general anesthesia for a procedure that does not normally require it.
Note: Using modifier 23 attests that proper documentation is on file to support the unusual anesthesia service.
| Modifier | Description | Rendering Physician |
|---|---|---|
| 23 | Unusual anesthesia | Informational |
Anesthesia Furnished in Conjunction with Colonoscopy
| Modifiers | Description | Rendering Physician |
|---|---|---|
| 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), the service may be identified by adding modifier 33 to the procedure code | Anesthesiologist or Physicians |
For separately reported services specifically identified as preventive, the modifier should not be used. For more details, you may refer to: MLN Matters® MM8874: Preventive and Screening Services – Update – Intensive Behavioral Therapy for Obesity, Screening Digital Tomosynthesis Mammography, and Anesthesia Associated with Screening Colonoscopy.
Physical Status Modifiers
| Modifiers | Description |
|---|---|
| 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 being removed for donor purposes |
Note: Medicare does not recognize Physical Status P modifiers. If using these modifiers, append as the last modifier. These modifiers are informational only and do not affect payment.
Distinct Procedural Services 59 and Subset Modifiers
Modifier 59 and/or the new four subset modifiers of 59 require the medical record to substantiate that the procedure or service was a distinct or separate services performed on the same day.
| Modifiers | Description | Rendering Physician |
|---|---|---|
| 59 | Distinct Procedural Service | Anesthesiologist/Physician |
| XE | Separate Encounter: A service that is distinct because it occurred during a separate encounter | Anesthesiologist/Physician |
| XS | Separate Structure: A service that is distinct because it was performed on a separate organ/structure | Anesthesiologist/Physician |
| XP | Separate Practitioner: A service that is distinct because it was performed by a different practitioner | Anesthesiologist/Physician |
| XU | Unusual Non-overlapping Service: The use of a service that is distinct because it does not overlap usual components of the main service | Anesthesiologist/Physician |
Revised 11/16/2023