• Submit CPT modifier 73 for Ambulatory Surgery Center (ASC) facility charges when the surgical procedure is discontinued before 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 that specifies 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; and
• For dates of service on or after January 1, 2008, HCPCS modifier SG is no longer required on cliams from ASCs for facility charges
• 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 reference will not be covered
• If Intraocular Lens (IOL) Insertion is terminated, the allowance for the unused IOL will be deducted prior to payment

• CMS Pub. 100-04, chapter 14, Section 10.3 & 10.4 and 40.4 (PDF, 902 KB)
• CMS Ambulatory Surgical Center Web page

No documents found