CPT Modifier 74

• Submit CPT modifier 74 for ambulatory surgery center (ASC) facility charges when the surgical procedure is discontinued after anesthesia is administered
• This modifier may not be submitted by the operating surgeon. Only ASCs should submit this modifier. Surgeons may refer to CPT modifier 53.
• ASC claims that involve a terminated surgery must be accompanied by an operative report. The operative report should include the following:
  • Reason for termination of surgery
  • Description of services actually performed
  • Description of supplies actually provided
  • Services not performed that would have been if surgery had not been terminated
  • Supplies that would have been provided if the surgery had not been terminated
  • Time actually spent in each stage (e.g., pre-op, operative and post-op)
  • Time that would have been spent in each of these stages if the surgery had not been terminated 
• Surgical procedures scheduled to be performed in an ASC that are terminated are subject to specific reimbursement:
  • Procedure terminated before administration of anesthesia — 50 percent of fee schedule
  • Procedure terminated after administration of anesthesia — 100 percent of fee schedule
• Procedures terminated before the ASC has expended substantial resources will not be covered
• If intraocular lens (IOL) insertion is terminated, the allowance for the unused IOL will be deducted prior to payment

Reference: Internet Only Manual (IOM), Publication 100-04, Chapter 14 (PDF, 182 KB).